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NPI Code Detail

MEDICARE: SUSAN YOUNG

MEDICARE: SUSAN YOUNG
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOTA 15133FL

General Provider Information

NPI Number : 1033563366
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN YOUNG
Provider Business Mailing Address
First Line : 4030 LUCIANO AVE
Second Line :
City : COCOA
State : FL
Zip : 32926-6814
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1140 7TH CT
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-5706
Country : US
Telephone Number : 772-584-3888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2016
Last Update Date : 04/23/2016

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Directions to “ SUSAN YOUNG ” Practice Location

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