Healthcare Provider Details

I. General information

NPI: 1184012585
Provider Name (Legal Business Name): HEALING TREE FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RIVER RD
EUGENE OR
97404-3230
US

IV. Provider business mailing address

1000 RIVER RD
EUGENE OR
97404-3230
US

V. Phone/Fax

Practice location:
  • Phone: 541-688-1569
  • Fax: 541-461-6884
Mailing address:
  • Phone: 541-688-1569
  • Fax: 541-461-6884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1162
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JERI LYNN OTTERSTROM
Title or Position: REGISTERED AGENT
Credential: ND
Phone: 541-688-1569