Provider Demographics
NPI:1720373921
Name:YOUNG, ELIZABETH RITA (OTR/L)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RITA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-5601
Mailing Address - Country:US
Mailing Address - Phone:309-241-8377
Mailing Address - Fax:309-353-8514
Practice Address - Street 1:2220 STATE ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3937
Practice Address - Country:US
Practice Address - Phone:309-353-8514
Practice Address - Fax:309-353-8514
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009095225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist