Healthcare Provider Details

I. General information

NPI: 1295016459
Provider Name (Legal Business Name): SARAH M YOUNG ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 RICHLAND MALL
ONTARIO OH
44906-3802
US

IV. Provider business mailing address

269 PORTLAND WAY S
GALION OH
44833-2312
US

V. Phone/Fax

Practice location:
  • Phone: 419-709-8645
  • Fax: 419-709-8646
Mailing address:
  • Phone: 419-709-8645
  • Fax: 419-709-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.003357
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: