Provider Demographics
NPI:1265841381
Name:ONEIL, BRENDANNE
Entity Type:Individual
Prefix:
First Name:BRENDANNE
Middle Name:
Last Name:ONEIL
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 1:202 ALMIRA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01119-1404
Mailing Address - Country:US
Mailing Address - Phone:413-386-3674
Mailing Address - Fax:
Practice Address - Street 1:202 ALMIRA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-1404
Practice Address - Country:US
Practice Address - Phone:413-386-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1491225200000X
MA8942225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant