Individual
EDWARD GEORGE DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1579 WELLINGTON LANE, 51, VISTA, CA 92081
(760) 717-4365
Mailing address
1579 WELLINGTON LANE, 51, VISTA, CA 92081
(760) 717-4365
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA1286
CA
Other
Enumeration date
02/12/2008
Last updated
02/12/2008
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