Active NPI
Jill Dougherty, OT
- Occupational Therapist
- Albany, NY
National Provider Identifier
1548870355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 004227-1
- Practice address
- 1367 Washington Ave Ste 100
Albany, NY 12206-1043 - Phone
- (518) 438-7926
- Fax
- (518) 438-8364
- NPI assigned
- Aug 6, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 004227-1 | NY | Primary |
Addresses
Primary practice location
1367 Washington Ave Ste 100
Albany, NY 12206-1043
Mailing address
711 Troy Schenectady Rd Ste 209
Latham, NY 12110-2481
Phone (518) 786-1667
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06254457 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 004227-1 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627862400000",
"number": "1548870355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "711 TROY SCHENECTADY RD STE 209",
"city": "LATHAM",
"state": "NY",
"postal_code": "121102481",
"telephone_number": "518-786-1667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1367 WASHINGTON AVE STE 100",
"city": "ALBANY",
"state": "NY",
"postal_code": "122061043",
"telephone_number": "518-438-7926",
"fax_number": "518-438-8364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "JILL",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-06",
"last_updated": "2021-08-02",
"certification_date": "2021-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "004227-1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06254457",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.