Provider Demographics
NPI:1275332736
Name:MCGAVOCK, CAROLINE (OTR/L)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MCGAVOCK
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 PINE NEEDLE WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-7921
Mailing Address - Country:US
Mailing Address - Phone:806-782-2964
Mailing Address - Fax:
Practice Address - Street 1:124 JOHN KING RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-8306
Practice Address - Country:US
Practice Address - Phone:850-634-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25991225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics