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General NPI Number Information
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NPI Number | 1720357130
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Entity Type | Organization
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Legal Business Name | YOUNG THERAPY, PC
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 302 DROPSEED DR
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City | SAVOY
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State | IL
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Zip | 61874-8521
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Country | US
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Telephone | 217-621-4441
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Fax | 866-401-1462
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Provider Business Mailing Address
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Address Line | 302 DROPSEED DR
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City | SAVOY
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State | IL
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Zip | 61874-8521
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Country | US
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Telephone | 217-621-4441
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Fax | 866-401-1462
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Authorized Official
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Title or Position | OWNER
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Name | MS. STACIE YOUNG
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Credential | MHS, OTR/L
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Telephone | 217-621-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 056005118
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License Number State | IL
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