Provider Demographics
NPI:1083284699
Name:O'NEAL, JESSICA LARAE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LARAE
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 MONTCLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1320
Mailing Address - Country:US
Mailing Address - Phone:330-612-9417
Mailing Address - Fax:
Practice Address - Street 1:721 E MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1331
Practice Address - Country:US
Practice Address - Phone:330-612-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist