Provider Demographics
NPI:1083014708
Name:O'NEIL, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 POSTAL ST
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:WV
Mailing Address - Zip Code:26055-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 POSTAL ST
Practice Address - Street 2:
Practice Address - City:PROCTOR
Practice Address - State:WV
Practice Address - Zip Code:26055-1316
Practice Address - Country:US
Practice Address - Phone:304-771-4082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer