Provider Demographics
NPI:1134343114
Name:YOUNGSTRAND, SCOTT GARY (OTR)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:GARY
Last Name:YOUNGSTRAND
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 GLACIER CT
Mailing Address - Street 2:
Mailing Address - City:MINNETRISTA
Mailing Address - State:MN
Mailing Address - Zip Code:55375-1349
Mailing Address - Country:US
Mailing Address - Phone:952-446-9019
Mailing Address - Fax:
Practice Address - Street 1:80 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1781
Practice Address - Country:US
Practice Address - Phone:651-481-8040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist