Provider Demographics
NPI:1760509459
Name:BUTTINE, SANDRA U (OTR)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:U
Last Name:BUTTINE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13739 SPRUCEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-3629
Mailing Address - Country:US
Mailing Address - Phone:972-392-4402
Mailing Address - Fax:
Practice Address - Street 1:12880 HILLCREST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1532
Practice Address - Country:US
Practice Address - Phone:972-387-1100
Practice Address - Fax:972-692-7332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103455225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist