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NPI Code Detail

MEDICARE: KETRINA YOUNG OT

MEDICARE:   KETRINA  YOUNG  OT
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
1225X00000XOccupational TherapistOT2017MS

General Provider Information

NPI Number : 1497839765
Entity Type Code : Individual
Provider Name (Legal Business Name) : KETRINA YOUNG OT
Provider Business Mailing Address
First Line : 1411 HIGHWAY 389
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-8451
Country : US
Telephone Number : 662-538-4739
Fax Number :
Provider Business Practice Location Address
First Line : 1411 HIGHWAY 389
Second Line :
City : STARKVILLE
State : MS
Zip : 39759-8451
Country : US
Telephone Number : 662-769-4888
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 06/05/2024

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Directions to “ KETRINA YOUNG OT” Practice Location

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