Provider Demographics
NPI:1265611446
Name:DOCHERTY, REBECCA HART
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:HART
Last Name:DOCHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 N LANSDOWNE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-1933
Mailing Address - Country:US
Mailing Address - Phone:843-669-6838
Mailing Address - Fax:
Practice Address - Street 1:2100 TWIN CHURCH RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8222
Practice Address - Country:US
Practice Address - Phone:843-637-0033
Practice Address - Fax:843-637-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist