Provider Demographics
NPI:1801100680
Name:O'SHAUGHNESSY, KATHLEEN ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:O'SHAUGHNESSY
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 1:7593 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2663
Mailing Address - Country:US
Mailing Address - Phone:330-757-9823
Mailing Address - Fax:
Practice Address - Street 1:7593 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-2663
Practice Address - Country:US
Practice Address - Phone:330-757-9823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5388225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics