Provider Demographics
NPI:1649032467
Name:DOUGHERTY, MELISSA PAULSON
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:PAULSON
Last Name:DOUGHERTY
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 1:1219 NW 104TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8059
Mailing Address - Country:US
Mailing Address - Phone:352-222-8433
Mailing Address - Fax:
Practice Address - Street 1:1219 NW 104TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8059
Practice Address - Country:US
Practice Address - Phone:352-222-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist