Provider Demographics
NPI:1356151989
Name:CRABTREE, TYLER JENNINGS (RN, LMT)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JENNINGS
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25368 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487-9783
Mailing Address - Country:US
Mailing Address - Phone:971-570-8352
Mailing Address - Fax:
Practice Address - Street 1:260 OAKWAY CTR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5663
Practice Address - Country:US
Practice Address - Phone:541-632-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200840875RN163W00000X
OR28734225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No163W00000XNursing Service ProvidersRegistered Nurse