Provider Demographics
NPI:1417006487
Name:YOUNG, CARRIE ANNE (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:ANNE
Other - Last Name:GEDDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:113 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3519
Mailing Address - Country:US
Mailing Address - Phone:503-263-8903
Mailing Address - Fax:503-266-8632
Practice Address - Street 1:27501 SW 95TH AVE
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-2905
Practice Address - Country:US
Practice Address - Phone:503-855-3223
Practice Address - Fax:503-266-8632
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1039896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR240075Medicaid
WA8461816Medicaid