Provider Demographics
NPI:1114660636
Name:YOUNG, CAMERON ALYSSA (OTD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:ALYSSA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 LONG RUN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4334
Mailing Address - Country:US
Mailing Address - Phone:502-244-8011
Mailing Address - Fax:
Practice Address - Street 1:1410 LONG RUN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4334
Practice Address - Country:US
Practice Address - Phone:502-244-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277284225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics