Provider Demographics
NPI:1417550898
Name:ERICKSON, PAIGE M (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:M
Other - Last Name:MELBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:215 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-857-4400
Mailing Address - Fax:701-857-4432
Practice Address - Street 1:215 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-857-4400
Practice Address - Fax:701-857-4432
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
ND1847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1482121Medicaid