Provider Demographics
NPI:1548738776
Name:DOUGHERTY, KAYLEE LIZABETH (BCO, CCA)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:LIZABETH
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:BCO, CCA
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:LIZABETH
Other - Last Name:DOMBROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-0245
Mailing Address - Country:US
Mailing Address - Phone:800-824-2492
Mailing Address - Fax:877-824-2413
Practice Address - Street 1:133 MORTLAND RD
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974-3337
Practice Address - Country:US
Practice Address - Phone:800-824-2492
Practice Address - Fax:877-824-2413
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist