Provider Demographics
NPI:1548762602
Name:DAUGHERTY, TAYLOR NICHOLE (OT)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:NICHOLE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 SHADYWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-9604
Mailing Address - Country:US
Mailing Address - Phone:281-413-6724
Mailing Address - Fax:
Practice Address - Street 1:5508 SHADYWOOD ST
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-9604
Practice Address - Country:US
Practice Address - Phone:281-413-6724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
117297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist