Provider Demographics
NPI:1447452446
Name:YOUNG, ERICA LYNN (OT)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYNN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:MANGINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2401 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-1891
Mailing Address - Fax:
Practice Address - Street 1:1375 S COLUMBIA RD - ALTRU PERFORMANCE CENTER
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:701-780-2238
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103134225X00000X
ND852225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist