Provider Demographics
NPI:1558528034
Name:CATHERINE YOUNG PLLC
Entity Type:Organization
Organization Name:CATHERINE YOUNG PLLC
Other - Org Name:KIDABILITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OT/L
Authorized Official - Phone:928-642-8747
Mailing Address - Street 1:PO BOX 11075
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-6668
Mailing Address - Country:US
Mailing Address - Phone:928-777-9897
Mailing Address - Fax:928-717-0019
Practice Address - Street 1:1045 WHIPPLE STREET
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1662
Practice Address - Country:US
Practice Address - Phone:928-777-9897
Practice Address - Fax:928-717-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3511225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ336623Medicaid