Active NPI
Lewayne A Young, COTA
- Occupational Therapy Assistant
- Winter Haven, FL
National Provider Identifier
1073725719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA9537
- Practice address
- 132 Alachua Dr
Winter Haven, FL 33884-1404 - Phone
- (863) 412-0320
- NPI assigned
- May 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA9537 | FL | Primary |
Addresses
Primary practice location
132 Alachua Dr
Winter Haven, FL 33884-1404
Mailing address
132 Alachua Drive
Winter Haven, FL 34112
Phone (863) 412-0320
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA9537 | FL | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073725719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "132 ALACHUA DRIVE",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "34112",
"telephone_number": "863-412-0320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "132 ALACHUA DR",
"city": "WINTER HAVEN",
"state": "FL",
"postal_code": "338841404",
"telephone_number": "863-412-0320"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "LEWAYNE",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "FL",
"license": "OTA9537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Haven, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.