Provider Demographics
NPI:1083220321
Name:YOUNG, JESSICA DAWN (DOT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DAWN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DOT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:MOOREFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26210 HARPER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2203
Mailing Address - Country:US
Mailing Address - Phone:888-485-8636
Mailing Address - Fax:586-218-3367
Practice Address - Street 1:26210 HARPER AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2203
Practice Address - Country:US
Practice Address - Phone:888-485-8636
Practice Address - Fax:586-218-3367
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics