Healthcare Provider Details

I. General information

NPI: 1205767480
Provider Name (Legal Business Name): HANNAH DOUGHERTY OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 SINASTA DR STE 4
ERWIN TN
37650-1724
US

IV. Provider business mailing address

2214 E FAIRVIEW AVE
JOHNSON CITY TN
37601-2860
US

V. Phone/Fax

Practice location:
  • Phone: 423-220-3317
  • Fax:
Mailing address:
  • Phone: 423-928-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: