Healthcare Provider Details

I. General information

NPI: 1457741803
Provider Name (Legal Business Name): ALEXANDRA YOUNG OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA JONES OT

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 SAINT MARYS RD
JUNCTION CITY KS
66441-4139
US

IV. Provider business mailing address

2812 W 12TH AVE
EMPORIA KS
66801-6202
US

V. Phone/Fax

Practice location:
  • Phone: 785-762-3350
  • Fax: 785-762-3920
Mailing address:
  • Phone: 620-208-7878
  • Fax: 620-208-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number17-03144
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: