Provider Demographics
NPI:1063545424
Name:DAUGHERTY, TIMOTHY PATRICK (OT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 EAST FRANKLIN STREET
Mailing Address - Street 2:BLDG. # 600
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514
Mailing Address - Country:US
Mailing Address - Phone:919-968-3456
Mailing Address - Fax:919-932-3456
Practice Address - Street 1:1829 EAST FRANKLIN STREET
Practice Address - Street 2:BLDG. # 600
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-968-3456
Practice Address - Fax:919-932-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4987225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301786Medicaid
NC1387GOtherBLUE CROSS