Healthcare Provider Details

I. General information

NPI: 1952205379
Provider Name (Legal Business Name): KYLIE BUTEL-PERKINS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SCHOOL ST STE 306
PAWTUCKET RI
02860-5337
US

IV. Provider business mailing address

349 DAVIS ST
PORTSMOUTH RI
02871-6245
US

V. Phone/Fax

Practice location:
  • Phone: 714-270-7066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: