Provider Demographics
NPI:1285153064
Name:YOUNG, JILLIAN C (COTA/L)
Entity type:Individual
Prefix:MISS
First Name:JILLIAN
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BANKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ARMONK
Mailing Address - State:NY
Mailing Address - Zip Code:10504-2617
Mailing Address - Country:US
Mailing Address - Phone:516-473-1840
Mailing Address - Fax:
Practice Address - Street 1:888 VETERANS HWY STE 310
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2940
Practice Address - Country:US
Practice Address - Phone:631-851-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist