Provider Demographics
NPI:1366872608
Name:YOUNG, JESSICA (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S MAIN ST
Mailing Address - Street 2:APT 1
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1135
Mailing Address - Country:US
Mailing Address - Phone:502-229-1550
Mailing Address - Fax:
Practice Address - Street 1:2150 LEXINGTON RD
Practice Address - Street 2:SUITE G
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7924
Practice Address - Country:US
Practice Address - Phone:859-333-8147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R5698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist