Nicole Blair Butler, M. ED.

Primary specialty

Developmental TherapistTaxonomy code 222Q00000X

Practice address

914 Shermer Rd
Northbrook, IL 60062-3729

Phone

(773) 456-8779

Fax

(847) 715-9270

NPI assigned

Sep 11, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Nicole Blair Gaynor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378857600000",
    "number": "1083049852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 SHERMER RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600623729",
            "telephone_number": "773-456-8779",
            "fax_number": "847-715-9270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 SHERMER RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600623729",
            "telephone_number": "773-456-8779",
            "fax_number": "847-715-9270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "NICOLE",
        "middle_name": "BLAIR",
        "name_prefix": "Mrs.",
        "credential": "M. ED.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-11",
        "last_updated": "2013-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "GAYNOR",
            "middle_name": "BLAIR",
            "prefix": "MS.",
            "credential": "M.ED.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kyle Burke, D.C.
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• Nate Buursma
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• Developmental Therapist in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Developmental Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.