Most Relevant Information
Provider Data
| NPI Number: | 1003352014 |
| Provider Name: | IRENE BUTALA |
| Entity Type: | Individual |
| Taxonomy Code: | 224Z00000X |
| Specialty: | Occupational Therapy Assistant |
| License Number: | 057.004114 |
Most Important Dates
| Enumeration Date: | 01/13/2017 |
| Last Updated: | 01/13/2017 |
Provider Practice Location
471 W TERRA COTTA AVE
CRYSTAL LAKE
IL
600143434
Practice Location Phone/Fax
| Phone: | 8154550550 |
| Fax: |
Provider Mailing Location
471 W TERRA COTTA AVE
CRYSTAL LAKE
IL
600143434
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |