Provider Demographics
NPI:1134934037
Name:DOROUGH, SHYANN (OTR/L)
Entity type:Individual
Prefix:
First Name:SHYANN
Middle Name:
Last Name:DOROUGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 US HIGHWAY 82 W STE 103
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8010
Mailing Address - Country:US
Mailing Address - Phone:229-445-3255
Mailing Address - Fax:
Practice Address - Street 1:1430 US HIGHWAY 82 W STE 103
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8010
Practice Address - Country:US
Practice Address - Phone:229-445-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTLP002871225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist