Individual
MS. JENNY LAUREN DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(269) 369-3057
Mailing address
5000 S 5TH AVE, HINES, IL 60141-3030
(269) 369-3057
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
056.009092
IL
Other
Enumeration date
08/23/2010
Last updated
08/23/2010
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