Provider Demographics
NPI:1437856960
Name:YOUNG, TRACY CALDWELL (PHD, OTR/L)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:CALDWELL
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 SWAN LAKE DR APT 306
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-7264
Mailing Address - Country:US
Mailing Address - Phone:610-357-8638
Mailing Address - Fax:
Practice Address - Street 1:18 GOVERNMENT CENTER LN
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2639
Practice Address - Country:US
Practice Address - Phone:540-245-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119009784225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist