MEDICARE: WILLIAM G DOUGHERTY OT

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
1	225X00000X	Occupational Therapist	1089	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669440343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM G DOUGHERTY OT

Provider Business Mailing Address
First Line	:	PO BOX 241769
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99524-1769
Country	:	US
Telephone Number	:	907-770-2380
Fax Number	:	907-770-2341

Provider Business Practice Location Address
First Line	:	4100 LAKE OTIS PKWY
Second Line	:	STE 314
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5231
Country	:	US
Telephone Number	:	907-274-2425
Fax Number	:	907-274-2428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/26/2010

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Directions to “ WILLIAM G DOUGHERTY OT” Practice Location

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