Provider Demographics
NPI:1063821882
Name:YOUNG, KARMA (COTA/L)
Entity Type:Individual
Prefix:
First Name:KARMA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 N 2850 EAST RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:IL
Mailing Address - Zip Code:61737-9407
Mailing Address - Country:US
Mailing Address - Phone:309-241-8693
Mailing Address - Fax:
Practice Address - Street 1:700 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3244
Practice Address - Country:US
Practice Address - Phone:309-829-1268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057002334224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant