Provider Demographics
NPI:1306554399
Name:CRABTREE, SHANNON MARAN (OTD)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARAN
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11518 SE VIEW TOP LN
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-9081
Mailing Address - Country:US
Mailing Address - Phone:360-991-4953
Mailing Address - Fax:
Practice Address - Street 1:411 E CARPENTER LN
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-9326
Practice Address - Country:US
Practice Address - Phone:458-256-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR475093225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist