Individual
GREGORY SCOTT DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
339 E MAPLE ST, NORTH CANTON, OH 44720-2593
(330) 498-8200
Mailing address
11074 ALDINA DR, CONNEAUT LAKE, PA 16316-2718
(814) 382-2718
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP001416L
PA
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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