Healthcare Provider Details

I. General information

NPI: 1679134639
Provider Name (Legal Business Name): MATTHEW THOMAS YOUNG OTD, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LINEBERRY BLVD
MT JULIET TN
37122-5517
US

IV. Provider business mailing address

6398 MORTON RD
GREENBRIER TN
37073-5714
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4888
  • Fax:
Mailing address:
  • Phone: 615-557-3706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6281
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: