Provider Demographics
NPI:1134445125
Name:BUTLER, ALPHONSO (OT)
Entity type:Individual
Prefix:
First Name:ALPHONSO
Middle Name:
Last Name:BUTLER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 SAINT FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2145
Mailing Address - Country:US
Mailing Address - Phone:650-219-9290
Mailing Address - Fax:
Practice Address - Street 1:1350 SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-2145
Practice Address - Country:US
Practice Address - Phone:650-219-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10771171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor