Provider Demographics
NPI:1992493605
Name:DOUGHTY, CANDY LYNN
Entity type:Individual
Prefix:MRS
First Name:CANDY
Middle Name:LYNN
Last Name:DOUGHTY
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 1:116 IRVIN ST
Mailing Address - Street 2:
Mailing Address - City:IRVONA
Mailing Address - State:PA
Mailing Address - Zip Code:16656-7017
Mailing Address - Country:US
Mailing Address - Phone:814-312-2432
Mailing Address - Fax:
Practice Address - Street 1:951 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1426
Practice Address - Country:US
Practice Address - Phone:814-684-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP000980L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant