Basic Information
| Provider Information | |||||||||
| NPI: | 1427532191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRABTREE | ||||||||
| FirstName: | CORY | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1522 EAST US RTE 36 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | URBANA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376535583 | ||||||||
| FaxNumber: | 9376534787 | ||||||||
| Practice Location | |||||||||
| Address1: | 1522 EAST US RTE 36 | ||||||||
| Address2: | SUITE A | ||||||||
| City: | URBANA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376535583 | ||||||||
| FaxNumber: | 9376534787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2018 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.