Healthcare Provider Details

I. General information

NPI: 1669694188
Provider Name (Legal Business Name): CHRISTINE LEE YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINE LEE VIALL

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 OLD ALICE RD SUITE 600
BROWNSVILLE TX
78550
US

IV. Provider business mailing address

871 OLD ALICE RD SUITE 600
BROWNSVILLE TX
78550
US

V. Phone/Fax

Practice location:
  • Phone: 956-541-2102
  • Fax: 956-541-2502
Mailing address:
  • Phone: 956-541-2102
  • Fax: 956-541-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209327
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: