Provider Demographics
NPI:1881209732
Name:O'CALLAGHAN, MADELEINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:O'CALLAGHAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 N JEBAVY DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1208
Mailing Address - Country:US
Mailing Address - Phone:231-690-3116
Mailing Address - Fax:
Practice Address - Street 1:704 OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2386
Practice Address - Country:US
Practice Address - Phone:231-876-7443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist