Healthcare Provider Details

I. General information

NPI: 1730724097
Provider Name (Legal Business Name): CARMEN OLIVIA YOUNGBLOOD OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COMMERCE PARK N STE 1B
BEDFORD NH
03110-6950
US

IV. Provider business mailing address

1292 GOFFSTOWN RD
MANCHESTER NH
03102-2355
US

V. Phone/Fax

Practice location:
  • Phone: 603-644-8334
  • Fax:
Mailing address:
  • Phone: 479-366-7782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24620
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3292
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number119438
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2953
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: