Healthcare Provider Details

I. General information

NPI: 1396809810
Provider Name (Legal Business Name): KELLY YOUNG PARTAIN OTR,L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY LEE YOUNG OTR,L

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37937 HEATHER PL
DADE CITY FL
33525-5420
US

IV. Provider business mailing address

37937 HEATHER PL
DADE CITY FL
33525-5420
US

V. Phone/Fax

Practice location:
  • Phone: 813-714-5815
  • Fax: 813-779-1879
Mailing address:
  • Phone: 813-714-5815
  • Fax: 813-779-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT 6031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: