Provider Demographics
NPI:1982033056
Name:O'SHAUGHNESSY, CAITRIONA (PT/PEDS)
Entity Type:Individual
Prefix:
First Name:CAITRIONA
Middle Name:
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:PT/PEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 FALLS CREEK LN
Mailing Address - Street 2:APT 14
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-4772
Mailing Address - Country:US
Mailing Address - Phone:704-915-8493
Mailing Address - Fax:704-824-3999
Practice Address - Street 1:2675 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1478
Practice Address - Country:US
Practice Address - Phone:704-824-7800
Practice Address - Fax:704-824-2853
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist