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General NPI Number Information
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NPI Number | 1265062269
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Entity Type | Individual
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Provider Name | BAYLIE MICHELLE BUTLER
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Gender | Female
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Dates
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Enumeration Date | 01/19/2020
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Last Update Date | 01/19/2020
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Provider Practice Location Address
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Address Line | 2357 ROGUE RIVER DR
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City | SACRAMENTO
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State | CA
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Zip | 95826-2118
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Country | US
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Telephone | 916-369-2139
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Fax |
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Provider Business Mailing Address
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Address Line | 9508 SIERRA RIVER DR
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City | ELK GROVE
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State | CA
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Zip | 95624-6026
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Country | US
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Telephone | 916-430-3251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | Y3676713
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License Number State | CA
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