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NPI Code Detail

MEDICARE: KATHLEEN DOHERTY OTR/L

MEDICARE: KATHLEEN DOHERTY OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist517848OR

General Provider Information

NPI Number : 1447068317
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN DOHERTY OTR/L
Provider Business Mailing Address
First Line : 1136 JEFFREY CT N
Second Line :
City : NORTHBROOK
State : IL
Zip : 60062-4658
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2201 NW HIGHLAND AVE
Second Line :
City : GRANTS PASS
State : OR
Zip : 97526-3365
Country : US
Telephone Number : 224-456-6017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/24/2024
Last Update Date : 12/24/2024

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Directions to “ KATHLEEN DOHERTY OTR/L” Practice Location

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