Provider Demographics
NPI:1891824579
Name:DOUGHERTY, JENNIFER DAILEY (ATC, CMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAILEY
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:ATC, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 MOCKINGBIRD TRL
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-2038
Mailing Address - Country:US
Mailing Address - Phone:303-838-5239
Mailing Address - Fax:
Practice Address - Street 1:1551 MOCKINGBIRD TRL
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-2038
Practice Address - Country:US
Practice Address - Phone:303-838-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer