Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023444908 |
---|---|
Provider Name | Melissa Louise Butala |
First Address | Lancaster, CA 93534-2531 |
Second Address | Lancaster, CA 93534-2531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 23/09/2013 |