Healthcare Provider Details

I. General information

NPI: 1417550898
Provider Name (Legal Business Name): PAIGE M ERICKSON MOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE M MELBY MOT, OTR/L

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 10/18/2023
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 2ND ST SE
MINOT ND
58701
US

IV. Provider business mailing address

215 2ND ST SE
MINOT ND
58701
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-4400
  • Fax: 701-857-4432
Mailing address:
  • Phone: 701-857-4400
  • Fax: 701-857-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1847
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: