Provider Demographics
NPI:1386918134
Name:DOHERTY, KARYN LOUISE (LMT)
Entity type:Individual
Prefix:MS
First Name:KARYN
Middle Name:LOUISE
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3413
Mailing Address - Country:US
Mailing Address - Phone:503-265-9448
Mailing Address - Fax:
Practice Address - Street 1:19360 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9378
Practice Address - Country:US
Practice Address - Phone:503-645-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8114174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist