Provider Demographics
NPI:1992134225
Name:DAUGHARTY, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DAUGHARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 SHATTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2699
Mailing Address - Country:US
Mailing Address - Phone:989-399-2001
Mailing Address - Fax:989-790-5767
Practice Address - Street 1:5935 SHATTUCK RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2699
Practice Address - Country:US
Practice Address - Phone:989-399-2001
Practice Address - Fax:989-790-5767
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007017225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist