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General NPI Number Information
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NPI Number | 1114670007
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Entity Type | Individual
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Provider Name | TYLER PATTERSON
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Gender | Male
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Dates
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Enumeration Date | 01/31/2022
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 417 N WATER ST STE 104
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City | SILVERTON
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State | OR
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Zip | 97381-1645
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Country | US
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Telephone | 502-503-9093
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Fax |
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Provider Business Mailing Address
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Address Line | 417 N WATER ST # 104
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City | SILVERTON
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State | OR
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Zip | 97381-1645
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 26794
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License Number State | OR
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