Basic Information
| Provider Information | |||||||||
| NPI: | 1629217112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLAUGHERTY | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | LU | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PTA, ATRIC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TREADWELL | ||||||||
| OtherFirstName: | CAROL | ||||||||
| OtherMiddleName: | LU | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PTA,ATRIC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1663 GREENFIELD DR | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920213520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194405752 | ||||||||
| FaxNumber: | 6194406861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1663 GREENFIELD DR | ||||||||
| Address2: | |||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920213520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194405752 | ||||||||
| FaxNumber: | 6194406861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2009 | ||||||||
| LastUpdateDate: | 02/06/2009 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246Y00000X | AT 1923 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Spec/Tech, Health Info |
No ID Information.