Provider Demographics
NPI:1992107635
Name:DOUGHERTY, DONNA LYNN (BS, MS, OTR/L)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:BS, MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CAMBRIDGE CT
Mailing Address - Street 2:P.O. BOX 40
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2904
Mailing Address - Country:US
Mailing Address - Phone:215-896-2924
Mailing Address - Fax:
Practice Address - Street 1:50 CAMBRIDGE CT
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2904
Practice Address - Country:US
Practice Address - Phone:215-896-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC006282L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist