Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1548738776 |
---|---|
Provider Name | Kaylee Lizabeth Dougherty |
First Address | Searsport, ME 04974-0245 |
Second Address | Searsport, ME 04974-3337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/05/2020 |