Provider Demographics
NPI:1477759504
Name:O'NEAL, JACQULINE
Entity Type:Individual
Prefix:
First Name:JACQULINE
Middle Name:
Last Name:O'NEAL
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 1:4006 SHADY OAK DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-7012
Mailing Address - Country:US
Mailing Address - Phone:423-903-5918
Mailing Address - Fax:
Practice Address - Street 1:3201 KARI LN
Practice Address - Street 2:APT 1722
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75402-7200
Practice Address - Country:US
Practice Address - Phone:903-408-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2061750225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant