Healthcare Provider Details

I. General information

NPI: 1265414502
Provider Name (Legal Business Name): CATHERINE ELAINE MCDONOUGH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 NEWTOWN RD
VIRGINIA BEACH VA
23462-1116
US

IV. Provider business mailing address

2280 OPITZ BLVD STE 210
WOODBRIDGE VA
22191-3330
US

V. Phone/Fax

Practice location:
  • Phone: 757-473-8016
  • Fax: 757-473-3580
Mailing address:
  • Phone: 703-523-1680
  • Fax: 571-589-2009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0119001487
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number0119001487
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: