Provider Demographics
NPI:1750511085
Name:YOUNG, SUSAN A (OT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:Y
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:180 GRAND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3741
Mailing Address - Country:US
Mailing Address - Phone:510-835-2131
Mailing Address - Fax:510-444-2340
Practice Address - Street 1:180 GRAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3741
Practice Address - Country:US
Practice Address - Phone:510-835-2131
Practice Address - Fax:510-444-2340
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011111225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist