Provider Demographics
NPI:1194108076
Name:YOUNG, JULIA B (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 PAULELE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3546
Mailing Address - Country:US
Mailing Address - Phone:310-804-0570
Mailing Address - Fax:
Practice Address - Street 1:1930 KAMEHAMEHA IV RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2629
Practice Address - Country:US
Practice Address - Phone:310-804-0570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1109OtherBOARD OF OCCUPATIONAL THERAPY HAWAII