MEDICARE: MONTANA 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
1	225X00000X	Occupational Therapist	OT009414	GA

General Provider Information

NPI Number	:	1750191532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONTANA YOUNG OT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-497-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 MUNDY MILL RD STE 102B
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30504-8226
Country	:	US
Telephone Number	:	770-287-8821
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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Directions to “ MONTANA YOUNG OT” Practice Location

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