Healthcare Provider Details

I. General information

NPI: 1134343114
Provider Name (Legal Business Name): SCOTT GARY YOUNGSTRAND OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MINNESOTA AVE
LITTLE CANADA MN
55117-1781
US

IV. Provider business mailing address

3838 GLACIER CT
MINNETRISTA MN
55375-1349
US

V. Phone/Fax

Practice location:
  • Phone: 651-481-8040
  • Fax:
Mailing address:
  • Phone: 952-446-9019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number101765
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: