Provider Demographics
NPI:1326407594
Name:O'NEILL, STACEY (ATC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:O'NEILL
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 1:1162 EDEN TER
Mailing Address - Street 2:WINTHROP UNIVERSITY WEST CENTER
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3208
Mailing Address - Country:US
Mailing Address - Phone:601-931-4338
Mailing Address - Fax:
Practice Address - Street 1:1162 EDEN TER
Practice Address - Street 2:WINTHROP UNIVERSITY WEST CENTER
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3208
Practice Address - Country:US
Practice Address - Phone:601-931-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer