Healthcare Provider Details

I. General information

NPI: 1013004720
Provider Name (Legal Business Name): RENEE LINDA YOUNG OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD 117(W)
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

1939 WINCHESTER RD
LYNDHURST OH
44124-3712
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-707-5936
Mailing address:
  • Phone: 440-446-9063
  • Fax: 216-707-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number508
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: