Provider Demographics
NPI:1992896658
Name:DAUGHERTY, STEPHANIE EMMA (OTR, CHT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EMMA
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:EMMA
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR, CHT
Mailing Address - Street 1:18346 DUTCHESS DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1725
Mailing Address - Country:US
Mailing Address - Phone:301-570-4650
Mailing Address - Fax:
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-962-7612
Practice Address - Fax:301-570-4650
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05945225XH1200X, 225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation