Healthcare Provider Details

I. General information

NPI: 1205854098
Provider Name (Legal Business Name): YLISA C YOUNG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11482 OKEECHOBEE BLVD STE 2
ROYAL PALM BEACH FL
33411-8735
US

IV. Provider business mailing address

6169 S JOG RD STE A11
LAKE WORTH FL
33467-6586
US

V. Phone/Fax

Practice location:
  • Phone: 561-432-0111
  • Fax: 561-431-1075
Mailing address:
  • Phone: 561-432-0111
  • Fax: 561-432-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOTOOO1330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: