Provider Demographics
NPI:1578808721
Name:YOUNG, STEPHANIE TSAI LUEN (OTR)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:TSAI LUEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 E SPRING ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-7197
Mailing Address - Country:US
Mailing Address - Phone:360-440-5356
Mailing Address - Fax:
Practice Address - Street 1:2150 FIRCREST DR SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2640
Practice Address - Country:US
Practice Address - Phone:360-443-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 60303423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist