Provider Demographics
NPI:1427474352
Name:YOUNG, TYNA (COTA/L)
Entity type:Individual
Prefix:MS
First Name:TYNA
Middle Name:
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 1:1311 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3209
Mailing Address - Country:US
Mailing Address - Phone:937-865-9285
Mailing Address - Fax:
Practice Address - Street 1:115 S. LUDLOW ST
Practice Address - Street 2:DAYTON BOARD OF EDUCATION
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3079
Practice Address - Country:US
Practice Address - Phone:937-542-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH324224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant