Active NPI
Kelly J Daugherty, MS, OTRL
- Occupational Therapist
- Watertown, NY
National Provider Identifier
1891832804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 014236-1
- Practice address
- 420 Gaffney Dr
Watertown, NY 13601-1823 - Phone
- (315) 782-2102
- Fax
- (315) 362-5303
- NPI assigned
- Jan 31, 2007
- 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 | 014236-1 | NY | Primary |
Addresses
Primary practice location
420 Gaffney Dr
Watertown, NY 13601-1823
Mailing address
1341 Marra Dr
Watertown, NY 13601-4433
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014236-1 | NY | MD | Psychologist |
| 014236 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225238400000",
"number": "1891832804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1341 MARRA DR",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136014433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 GAFFNEY DR",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136011823",
"telephone_number": "315-782-2102",
"fax_number": "315-362-5303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAUGHERTY",
"first_name": "KELLY",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "MS, OTRL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-31",
"last_updated": "2008-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "014236-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.