Individual
MICHELLE NICOLE DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
171 INTREPID LN, SYRACUSE, NY 13205-2548
(315) 437-4689
Mailing address
PO BOX 223, WESTMORELAND, NY 13490-0223
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
NY
Other
Enumeration date
09/10/2017
Last updated
09/10/2017
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