Provider Demographics
NPI:1508604901
Name:YOUNG, SADIE (OTDR/L)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTDR/L
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:
Other - Last Name:HARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5754
Mailing Address - Country:US
Mailing Address - Phone:901-259-1673
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:6286 BRIARCREST AVE STE 110
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4023
Practice Address - Country:US
Practice Address - Phone:901-261-2506
Practice Address - Fax:901-259-1698
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8027225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist