Provider Demographics
NPI:1497776223
Name:DOHERTY, MARGARET ELLEN (ATC)
Entity Type:Individual
Prefix:MISS
First Name:MARGARET
Middle Name:ELLEN
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FERNDALE RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7407
Mailing Address - Country:US
Mailing Address - Phone:973-694-2189
Mailing Address - Fax:973-633-3114
Practice Address - Street 1:272 BERDAN AVE
Practice Address - Street 2:WAYNE HILLS HIGH SCHOOL
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3240
Practice Address - Country:US
Practice Address - Phone:973-633-3194
Practice Address - Fax:973-633-3114
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000257002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer