Provider Demographics
NPI:1376312983
Name:YOUNG, DARNELL ELIZABETH (OTA)
Entity Type:Individual
Prefix:MRS
First Name:DARNELL
Middle Name:ELIZABETH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MISS
Other - First Name:DARNELL
Other - Middle Name:ELIZABETH
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1411
Mailing Address - Country:US
Mailing Address - Phone:132-036-0588
Mailing Address - Fax:
Practice Address - Street 1:605 MAIN STREET
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:58381
Practice Address - Country:US
Practice Address - Phone:320-360-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN201074224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant