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NPI Code Detail

MEDICARE: MICHELE DOUGHERTY MS, OTR/L

MEDICARE: MICHELE DOUGHERTY MS, 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
1225XP0200XPediatric Occupational Therapist0119008061VA

General Provider Information

NPI Number : 1356706121
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELE DOUGHERTY MS, OTR/L
Provider Business Mailing Address
First Line : 10150 VILLAGE KNOLLS CT
Second Line :
City : OAKTON
State : VA
Zip : 22124-2728
Country : US
Telephone Number : 914-471-0176
Fax Number :
Provider Business Practice Location Address
First Line : 1768 BUSINESS CENTER DR STE 330
Second Line :
City : RESTON
State : VA
Zip : 20190-4882
Country : US
Telephone Number : 186-691-9324
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2015
Last Update Date : 08/17/2023

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