Provider Demographics
NPI:1295218030
Name:YOUNG, MAKAYLA BROOKE (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:BROOKE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:MAKAYLA
Other - Middle Name:BROOKE
Other - Last Name:WYKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-6276
Mailing Address - Country:US
Mailing Address - Phone:304-842-0044
Mailing Address - Fax:304-842-0033
Practice Address - Street 1:387 HELIPORT LOOP
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-8604
Practice Address - Country:US
Practice Address - Phone:304-842-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2112225X00000X
OH010285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist