Provider Demographics
NPI:1609657501
Name:O'NEILL, CAROLINE ASHBAUGH (LMT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ASHBAUGH
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 MOSBY DR SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2606
Mailing Address - Country:US
Mailing Address - Phone:703-431-2167
Mailing Address - Fax:
Practice Address - Street 1:821 S KING ST STE B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3914
Practice Address - Country:US
Practice Address - Phone:703-431-2167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006735225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist