Provider Demographics
NPI:1366636698
Name:DOHERTY, KATHERINE HALEY (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HALEY
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BIRD ST
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3201
Mailing Address - Country:US
Mailing Address - Phone:781-718-4491
Mailing Address - Fax:
Practice Address - Street 1:1400 LOWELL RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-5210
Practice Address - Country:US
Practice Address - Phone:978-402-1473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA018562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer