MEDICARE: SHELLEY KAYE YOUNGBLOOD MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	6696	SC
2	225X00000X	Occupational Therapist	0119011348	VA

General Provider Information

NPI Number	:	1134375025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY KAYE YOUNGBLOOD MS, OTR/L

Provider Business Mailing Address
First Line	:	198 OLD MILL RD NE
Second Line	:
City	:	FLOYD
State	:	VA
Zip	:	24091-3732
Country	:	US
Telephone Number	:	503-351-5489
Fax Number	:

Provider Business Practice Location Address
First Line	:	198 OLD MILL RD NE
Second Line	:
City	:	FLOYD
State	:	VA
Zip	:	24091-3732
Country	:	US
Telephone Number	:	503-351-5489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	04/08/2026

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