Healthcare Provider Details

I. General information

NPI: 1306018858
Provider Name (Legal Business Name): AUDREY E SAWNEY-YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S CONGRESS AVE
LAKE WORTH FL
33461-4746
US

IV. Provider business mailing address

921 W 1ST ST
RIVIERA BEACH FL
33404-7609
US

V. Phone/Fax

Practice location:
  • Phone: 561-967-6500
  • Fax:
Mailing address:
  • Phone: 561-881-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA8043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: