Provider Demographics
NPI:1093090870
Name:O'NEILL, COLIN JS (LMP)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:JS
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27553
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98165-2553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 NE 125TH ST
Practice Address - Street 2:APT #6
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4348
Practice Address - Country:US
Practice Address - Phone:206-359-5036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60247285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist