Provider Demographics
NPI:1538686217
Name:DOUGHTY, OLIVIA M (CTRS)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:M
Last Name:DOUGHTY
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4083 DOGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44847-9443
Mailing Address - Country:US
Mailing Address - Phone:419-681-3329
Mailing Address - Fax:
Practice Address - Street 1:32 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2662
Practice Address - Country:US
Practice Address - Phone:419-681-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH69787225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist