Healthcare Provider Details

I. General information

NPI: 1932351863
Provider Name (Legal Business Name): JESSICA H YOUNT OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MAIN ST
SUMMERTON SC
29148-6904
US

IV. Provider business mailing address

1271 COTTAGE DR
SUMMERTON SC
29148-7008
US

V. Phone/Fax

Practice location:
  • Phone: 803-460-4655
  • Fax: 803-488-0031
Mailing address:
  • Phone: 803-460-4655
  • Fax: 803-488-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2686
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: