Provider Demographics
NPI:1962753731
Name:YOUNG, KAYLI (OTR/L)
Entity type:Individual
Prefix:
First Name:KAYLI
Middle Name:
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 1:1897 NE 146TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1897 NE 146TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-1423
Practice Address - Country:US
Practice Address - Phone:305-949-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 15352225X00000X
NY017450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY017450OtherOCCUPATIONAL THERAPY LICENSE
FLOT 15352OtherOCCUPATIONAL THERAPY LICENSE
294309OtherNATIONAL BOARD FOR CERTIFICATION OF OCCUPATIONAL THERAPY (NBCOT) CERTIFIED