Provider Demographics
NPI:1437648094
Name:YOUNG, RACHAEL NEVADA (OT)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:NEVADA
Last Name:YOUNG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1590
Mailing Address - Country:US
Mailing Address - Phone:859-285-0915
Mailing Address - Fax:
Practice Address - Street 1:2600 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1590
Practice Address - Country:US
Practice Address - Phone:859-572-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-11-10
Deactivation Date:2024-08-24
Deactivation Code:
Reactivation Date:2024-10-17
Provider Licenses
StateLicense IDTaxonomies
OHOT013026225X00000X
KY294693225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDIV907908052OtherANTHEM BLUE CROSS BLUE SHIELD