MEDICARE: SUSAN A 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	OC011111	PA

General Provider Information

NPI Number	:	1750511085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A YOUNG OT

Provider Business Mailing Address
First Line	:	180 GRAND AVE
Second Line	:	SUITE 300
City	:	OAKLAND
State	:	CA
Zip	:	94612-3741
Country	:	US
Telephone Number	:	510-835-2131
Fax Number	:	510-444-2340

Provider Business Practice Location Address
First Line	:	180 GRAND AVE
Second Line	:	SUITE 300
City	:	OAKLAND
State	:	CA
Zip	:	94612-3741
Country	:	US
Telephone Number	:	510-835-2131
Fax Number	:	510-444-2340

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

Provider Enumeration Date	:	07/21/2009
Last Update Date	:	05/10/2012

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