Basic Information
| Provider Information | |||||||||
| NPI: | 1417396177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | OTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1143 BEEBE RD | ||||||||
| Address2: | |||||||||
| City: | HARRINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199521918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434972606 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 DUTCHMANS LN | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216013346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108224000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2013 | ||||||||
| LastUpdateDate: | 06/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | T00270 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | 224Z00000X | U2-0001376 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.