Crystal Tyson, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056011193 Issued in IL

Practice address

4121 Veterans Memorial Dr
Mount Vernon, IL 62864-6262

Phone

(618) 242-3778

Fax

(618) 242-2551

NPI assigned

Sep 21, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Comprehensive Therapeutics LTD

  • Physical Therapist
  • North Riverside, IL
  • NPI 1699094102

  Occupational Therapist

  Medicare reassignment NPD
• Herron Rehab and Wellness Center, S.C.

  • Occupational Therapist
  • West Frankfort, IL
  • NPI 1710110861
  Medicare reassignment NPD
• Comprehensive Therapeutics LTD

  • Physical Therapist
  • Lagrange, GA
  • NPI 1881458354

  Occupational Therapist

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442793600000",
    "number": "1629447529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-242-3778",
            "fax_number": "618-242-2551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-242-3778",
            "fax_number": "618-242-2551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "CRYSTAL",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-21",
        "last_updated": "2015-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056011193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "056011193",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tyson Wayne Tinsley, D.M.D.
• Diana L Tomlianovich, PMHNP-BC
• Cynthia Travis, RN
• Jitendra Trivedi, MD
• Kristie Turner, P.T.
• United Cerebral Palsy of Southern Illinois,Inc.
• United Methodist Children'S Home of Southern Illinois Inc.
• United Skin Specialists Illinois LTD, PC
• United Skin Specialists Illinois LTD, PC
• University Hematology Oncology Inc

• Occupational Therapist in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.