Provider Demographics
NPI:1588242309
Name:DOUGHERTY, ANDREA LEIGH (OTR/L)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:LEIGH
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 24TH ST W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-3861
Mailing Address - Country:US
Mailing Address - Phone:406-534-9064
Mailing Address - Fax:
Practice Address - Street 1:483 S 44TH ST W APT 4110
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-3974
Practice Address - Country:US
Practice Address - Phone:406-534-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-10495225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist