Provider Demographics
NPI:1336298827
Name:OSHAUGHNESSY, LAURIE MARIE (MSPT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:MARIE
Last Name:OSHAUGHNESSY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:CARNELIAN BAY
Mailing Address - State:CA
Mailing Address - Zip Code:96140-1387
Mailing Address - Country:US
Mailing Address - Phone:530-546-7581
Mailing Address - Fax:530-546-7869
Practice Address - Street 1:215 CARNELIAN BAY ST.
Practice Address - Street 2:SUITE A
Practice Address - City:CARNELIAN BAY
Practice Address - State:CA
Practice Address - Zip Code:96140
Practice Address - Country:US
Practice Address - Phone:530-546-7581
Practice Address - Fax:530-546-7869
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13704OtherSTATE PT LICENSE
CAPT13704OtherSTATE PT LICENSE