Provider Demographics
NPI:1366100299
Name:DELVALLE-YOUNG, LAURIE MARIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
Last Name:DELVALLE-YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-3256
Mailing Address - Country:US
Mailing Address - Phone:219-616-3913
Mailing Address - Fax:
Practice Address - Street 1:74 JOURNEY WAY
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-0078
Practice Address - Country:US
Practice Address - Phone:219-255-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist