Provider Demographics
NPI:1629217112
Name:MCCLAUGHERTY, CAROL LU (PTA, ATRIC)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:LU
Last Name:MCCLAUGHERTY
Suffix:
Gender:F
Credentials:PTA, ATRIC
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:LU
Other - Last Name:TREADWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA,ATRIC
Mailing Address - Street 1:1663 GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3520
Mailing Address - Country:US
Mailing Address - Phone:619-440-5752
Mailing Address - Fax:619-440-6861
Practice Address - Street 1:1663 GREENFIELD DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3520
Practice Address - Country:US
Practice Address - Phone:619-440-5752
Practice Address - Fax:619-440-6861
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 1923246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information