MEDICARE: KYLE 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
1	225X00000X	Occupational Therapist	103196	MN

General Provider Information

NPI Number	:	1043477490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE YOUNG

Provider Business Mailing Address
First Line	:	1416 FAIRGROUNDS RD
Second Line	:
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65109-0474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 FAIRGROUNDS RD
Second Line	:
City	:	JEFFERSON CTY
State	:	MO
Zip	:	65109-0474
Country	:	US
Telephone Number	:	573-280-6494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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Directions to “ KYLE YOUNG ” Practice Location

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