Basic Information
| Provider Information | |||||||||
| NPI: | 1982033056 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | O'SHAUGHNESSY | ||||||||
| FirstName: | CAITRIONA | ||||||||
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| Credential: | PT/PEDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1027 FALLS CREEK LN | ||||||||
| Address2: | APT 14 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282094772 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049158493 | ||||||||
| FaxNumber: | 7048243999 | ||||||||
| Practice Location | |||||||||
| Address1: | 2675 COURT DR | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280541478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048247800 | ||||||||
| FaxNumber: | 7048242853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2013 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 14560 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.