Provider Demographics
NPI:1720357130
Name:YOUNG THERAPY, PC
Entity Type:Organization
Organization Name:YOUNG THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, OTR/L
Authorized Official - Phone:217-621-4441
Mailing Address - Street 1:302 DROPSEED DR
Mailing Address - Street 2:
Mailing Address - City:SAVOY
Mailing Address - State:IL
Mailing Address - Zip Code:61874-8521
Mailing Address - Country:US
Mailing Address - Phone:217-621-4441
Mailing Address - Fax:866-401-1462
Practice Address - Street 1:302 DROPSEED DR
Practice Address - Street 2:
Practice Address - City:SAVOY
Practice Address - State:IL
Practice Address - Zip Code:61874-8521
Practice Address - Country:US
Practice Address - Phone:217-621-4441
Practice Address - Fax:866-401-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056005118225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty