Provider Demographics
NPI:1710619168
Name:YOUNG, MEGAN CHRISTINA (COTA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CHRISTINA
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 1:1831 DOROTHY CIR LOT 82
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-9418
Mailing Address - Country:US
Mailing Address - Phone:989-280-0851
Mailing Address - Fax:
Practice Address - Street 1:568 N PINE RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-9190
Practice Address - Country:US
Practice Address - Phone:989-778-1713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007787224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant