Healthcare Provider Details

I. General information

NPI: 1902700412
Provider Name (Legal Business Name): LAURA YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W GRAND RIVER AVE
HOWELL MI
48843-1916
US

IV. Provider business mailing address

PO BOX 399
DEXTER MI
48130-0399
US

V. Phone/Fax

Practice location:
  • Phone: 517-546-5550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201001629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: