MEDICARE: TAYVA 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	225700000X	Massage Therapist	MT6361	ME

General Provider Information

NPI Number	:	1326714668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYVA YOUNG

Provider Business Mailing Address
First Line	:	439 BAUNEG BEG HILL RD
Second Line	:
City	:	NORTH BERWICK
State	:	ME
Zip	:	03906-5103
Country	:	US
Telephone Number	:	978-257-0249
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 ELM ST
Second Line	:
City	:	NORTH BERWICK
State	:	ME
Zip	:	03906-6725
Country	:	US
Telephone Number	:	207-200-7586
Fax Number	:

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

Provider Enumeration Date	:	08/17/2021
Last Update Date	:	08/17/2021

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Directions to “ TAYVA YOUNG ” Practice Location

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