Provider Demographics
NPI:1437314192
Name:DAUGHERTY, DEANNA KAY (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:KAY
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HAWKINS DR.
Mailing Address - Street 2:ROOM 333, CENTER FOR DISABILITIES & DEVELOPMENT
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1011
Mailing Address - Country:US
Mailing Address - Phone:319-356-1515
Mailing Address - Fax:319-384-9393
Practice Address - Street 1:100 HAWKINS DR
Practice Address - Street 2:ROOM 333
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1016
Practice Address - Country:US
Practice Address - Phone:319-356-1515
Practice Address - Fax:319-384-9393
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00142224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant