Healthcare Provider Details

I. General information

NPI: 1174875751
Provider Name (Legal Business Name): SCHAILLEE BUTLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVE DEPARTMENT OF ORTHOPEDICS
BOSTON MA
02120-2847
US

IV. Provider business mailing address

125 PARKER HILL AVE DEPARTMENT OF ORTHOPEDICS
BOSTON MA
02120-2847
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4445
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: