Provider Demographics
NPI:1689901522
Name:YOUNG, BRITTNEY MICHELLE (COTA)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:MICHELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 LOWER AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:MS
Mailing Address - Zip Code:39455-9151
Mailing Address - Country:US
Mailing Address - Phone:601-447-0168
Mailing Address - Fax:
Practice Address - Street 1:277 LOWER AIRPORT RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:MS
Practice Address - Zip Code:39455-9151
Practice Address - Country:US
Practice Address - Phone:601-447-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSTA2164224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant