Provider Demographics
NPI:1417180407
Name:O'NEILL, JAMAL (LMT)
Entity Type:Individual
Prefix:MS
First Name:JAMAL
Middle Name:
Last Name:O'NEILL
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 1:634 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-2926
Mailing Address - Country:US
Mailing Address - Phone:716-574-3053
Mailing Address - Fax:
Practice Address - Street 1:501 W KLEIN RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-1603
Practice Address - Country:US
Practice Address - Phone:716-689-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020483225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist