Provider Demographics
NPI:1104942952
Name:DOHERTY, KAREN LOUISE (OTR)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LOUISE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NESTLEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-2436
Mailing Address - Country:US
Mailing Address - Phone:508-496-6142
Mailing Address - Fax:
Practice Address - Street 1:4 NESTLEBROOK LN
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-2436
Practice Address - Country:US
Practice Address - Phone:508-496-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6991225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist