Provider Demographics
NPI:1265740922
Name:O'CALLAGHAN, MARY KATHRYN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHRYN
Last Name:O'CALLAGHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 VIOLET DR
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1209
Mailing Address - Country:US
Mailing Address - Phone:845-215-9260
Mailing Address - Fax:
Practice Address - Street 1:160 VAN WYCK RD
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1229
Practice Address - Country:US
Practice Address - Phone:845-680-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021054-1225100000X
NJ40QA00719500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist