Provider Demographics
NPI:1295954576
Name:DOUGHERTY, MARY (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:POWERS-SPRAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:9 EXECUTIVE CAMPUS
Mailing Address - Street 2:PATHS, LLC
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4502
Mailing Address - Country:US
Mailing Address - Phone:856-671-6000
Mailing Address - Fax:856-671-6015
Practice Address - Street 1:2901 EMRICK BLVD
Practice Address - Street 2:LEHIGH VALLEY HEALTH REHABILITATION SERVICES,
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8017
Practice Address - Country:US
Practice Address - Phone:610-625-2169
Practice Address - Fax:610-625-2278
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC909-L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist