Provider Demographics
NPI:1174982888
Name:ONEIL, MEGHAN (ATC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:ONEIL
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEST ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1372
Mailing Address - Country:US
Mailing Address - Phone:315-345-8113
Mailing Address - Fax:
Practice Address - Street 1:34 CORNELL DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1037
Practice Address - Country:US
Practice Address - Phone:315-386-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002564-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer