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Individual

KELLY DAUGHERTY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
14188 W 150TH CT, OLATHE, KS 66062-3367
(913) 829-7775
Mailing address
17654 W 159TH TER, OLATHE, KS 66062-4000

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
225XH1300X
Human Factors Occupational Therapist
225XN1300X
Neurorehabilitation Occupational Therapist
225XP0200X
Pediatric Occupational Therapist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
38998016
BLUE CROSS/BLUE SHIELD
Enumeration date
02/08/2008
Last updated
02/08/2008
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