Active NPI
Jacob Larry Butler
- Occupational Therapist
- Provo, UT
National Provider Identifier
1972908762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 11351103-4201
- Practice address
- 1034 N 500 W
Provo, UT 84604-3337 - Phone
- (801) 357-7850
- NPI assigned
- Oct 23, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Occupational Therapist | 225X00000X | 11351103-4201 | UT | Primary |
Addresses
Primary practice location
1034 N 500 W
Provo, UT 84604-3337
Mailing address
3613 E Golden Eagle Rd
Eagle Mountain, UT 84005-3866
Phone (435) 650-7021
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11351103-4201 | UT | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1972908762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3613 E GOLDEN EAGLE RD",
"city": "EAGLE MOUNTAIN",
"state": "UT",
"postal_code": "840053866",
"telephone_number": "435-650-7021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1034 N 500 W",
"city": "PROVO",
"state": "UT",
"postal_code": "846043337",
"telephone_number": "801-357-7850"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTLER",
"first_name": "JACOB",
"middle_name": "LARRY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-23",
"last_updated": "2021-11-08",
"certification_date": "2021-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "UT",
"license": "11351103-4201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.