Provider Demographics
NPI:1265414502
Name:MCDONOUGH, CATHERINE ELAINE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ELAINE
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 OPITZ BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3330
Mailing Address - Country:US
Mailing Address - Phone:703-523-1680
Mailing Address - Fax:571-589-2009
Practice Address - Street 1:818 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1116
Practice Address - Country:US
Practice Address - Phone:757-473-8016
Practice Address - Fax:757-473-3580
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001487225X00000X, 224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
11454099OtherCAQH
35062OtherOPTIMA
4980093OtherVIRGINIA PREMIER HEALTH
6400313OtherUNITED HEALTH CARE
7542588OtherAETNA
VA4980093Medicaid
VA9116460OtherMEDICAID DME
103836OtherANTHEM BLUE CROSS
VA4980093Medicaid