Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 4987 | NC |
N | 225XP0200X | Occupational Therapist - Pediatrics | 4987 | NC |
NPI | 1063545424 |
---|---|
Provider Name | Mr. Timothy Patrick Daugherty |
First Address | Chapel Hill, NC 27514 |
Second Address | Chapel Hill, NC 27514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1387G | BLUE CROSS (01) | NC |
7301786 | (05) | NC |