Provider Demographics
NPI:1164738506
Name:O'NEAL, MICHAEL TRENT JR (ATC, SCAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TRENT
Last Name:O'NEAL
Suffix:JR
Gender:M
Credentials:ATC, SCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:418 LONG NEEDLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9461
Mailing Address - Country:US
Mailing Address - Phone:803-521-1376
Mailing Address - Fax:803-227-8221
Practice Address - Street 1:104 SALUDA POINTE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7295
Practice Address - Country:US
Practice Address - Phone:803-227-8155
Practice Address - Fax:803-227-8221
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7432255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer