Provider Demographics
NPI:1699244236
Name:YOUNG, REBECCA ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:REBECCA
Other - Middle Name:ANN
Other - Last Name:SPORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:36785 BELLCREST CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-3484
Mailing Address - Country:US
Mailing Address - Phone:440-934-1099
Mailing Address - Fax:
Practice Address - Street 1:3075 STONEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1821
Practice Address - Country:US
Practice Address - Phone:440-934-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT004397225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist