Provider Demographics
NPI:1295303790
Name:YOUNG, JOYCE (OT)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:HUMPHRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 KOPF RD
Mailing Address - Street 2:
Mailing Address - City:SENATOBIA
Mailing Address - State:MS
Mailing Address - Zip Code:38668-9200
Mailing Address - Country:US
Mailing Address - Phone:901-413-4589
Mailing Address - Fax:
Practice Address - Street 1:1325 MCINGVALE RD
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1013
Practice Address - Country:US
Practice Address - Phone:662-428-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TN4349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist