Provider Demographics
NPI:1366500365
Name:O'NEAL, SUSAN L (LMT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3563
Mailing Address - Country:US
Mailing Address - Phone:407-421-7859
Mailing Address - Fax:407-622-6244
Practice Address - Street 1:1435 HOWELL BRANCH RD
Practice Address - Street 2:SUITE E.
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1157
Practice Address - Country:US
Practice Address - Phone:407-622-6244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA33819225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist