Healthcare Provider Details

I. General information

NPI: 1407281926
Provider Name (Legal Business Name): MARY COURTENAY DAUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 BURT RD STE 4
LEXINGTON KY
40503-2410
US

IV. Provider business mailing address

4451 ROSE DALE CT
LEXINGTON KY
40515-6324
US

V. Phone/Fax

Practice location:
  • Phone: 859-276-0335
  • Fax:
Mailing address:
  • Phone: 502-836-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: