Provider Demographics
NPI:1194816181
Name:MCNEILL, CHARLENE H
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:H
Last Name:MCNEILL
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 1:48 MEDICAL PARK DR E
Mailing Address - Street 2:SUITE 255
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3400
Mailing Address - Country:US
Mailing Address - Phone:205-838-3090
Mailing Address - Fax:205-838-6783
Practice Address - Street 1:1022 1ST ST N
Practice Address - Street 2:SUITE 220
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8706
Practice Address - Country:US
Practice Address - Phone:205-621-3778
Practice Address - Fax:205-621-4835
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALR81227Medicare UPIN
AL102I670702Medicare UPIN