Provider Demographics
NPI:1689618662
Name:LINDBERG, ERIN NICHOLE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICHOLE
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BAY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-4912
Mailing Address - Country:US
Mailing Address - Phone:218-847-3799
Mailing Address - Fax:
Practice Address - Street 1:115 WILLOW ST W
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3922
Practice Address - Country:US
Practice Address - Phone:218-850-8308
Practice Address - Fax:855-266-6722
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2246525OtherFIRST HEALTH
MN132711900Medicaid
MN273K7HAOtherBLUECROSSBLUESHIELD-MN
MN64-04793OtherMEDICA