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General NPI Number Information
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NPI Number | 1497776223
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Entity Type | Individual
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Provider Name | MARGARET ELLEN DOHERTY ATC
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 272 BERDAN AVE WAYNE HILLS HIGH SCHOOL
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City | WAYNE
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State | NJ
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Zip | 07470-3240
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Country | US
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Telephone | 973-633-3194
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Fax | 973-633-3114
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Provider Business Mailing Address
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Address Line | 6 FERNDALE RD
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City | WAYNE
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State | NJ
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Zip | 07470-7407
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Country | US
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Telephone | 973-694-2189
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Fax | 973-633-3114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 25MT00025700
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License Number State | NJ
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