Provider Demographics
NPI:1356627863
Name:DOHERTY, JULIA ANN (OTR)
Entity Type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:ANN
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 W 91ST ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60455-2045
Mailing Address - Country:US
Mailing Address - Phone:708-238-6793
Mailing Address - Fax:
Practice Address - Street 1:5333 N SHERIDAN RD
Practice Address - Street 2:GENESIS REHAB SERVICES, THE BREAKERS
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-7371
Practice Address - Country:US
Practice Address - Phone:773-271-5189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056009569225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist