Healthcare Provider Details

I. General information

NPI: 1275581787
Provider Name (Legal Business Name): JOHN J DOHERTY OTR/L, ATP
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: JAY DOHERTY OTR/L, ATP

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 COMMUNICATION DR
LACONIA NH
03246-1440
US

IV. Provider business mailing address

67 COMMUNICATION DR
LACONIA NH
03246-1440
US

V. Phone/Fax

Practice location:
  • Phone: 603-528-3060
  • Fax: 603-524-0702
Mailing address:
  • Phone: 603-528-3060
  • Fax: 603-524-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1026
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: