MEDICARE: MRS. MEGAN KUNIKO YOUNG MA, OTR/L

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	OT-3229	NV
2	225XP0200X	Pediatric Occupational Therapist	11600	CA

General Provider Information

NPI Number	:	1164728242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN KUNIKO YOUNG MA, OTR/L

Provider Business Mailing Address
First Line	:	307 SALINAS DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-3574
Country	:	US
Telephone Number	:	818-515-8267
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 SAINT ROSE PKWY STE H2-216
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7783
Country	:	US
Telephone Number	:	702-268-8513
Fax Number	:	702-852-0430

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

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	09/01/2023

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