Provider Demographics
NPI:1164398251
Name:YOUNG, NICOLLET SUE (OTD)
Entity type:Individual
Prefix:DR
First Name:NICOLLET
Middle Name:SUE
Last Name:YOUNG
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 1:15590 90TH ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-9452
Mailing Address - Country:US
Mailing Address - Phone:763-755-4275
Mailing Address - Fax:763-356-4105
Practice Address - Street 1:15590 90TH ST NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-9452
Practice Address - Country:US
Practice Address - Phone:763-755-4275
Practice Address - Fax:763-356-4105
Is Sole Proprietor?:No
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist