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:
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 1:13336 SW CHELSEA LOOP
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6062
Mailing Address - Country:US
Mailing Address - Phone:503-521-6219
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:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OR1039896225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8461816Medicaid
OR240075Medicaid