Provider Demographics
NPI:1518343953
Name:MCNEIL, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 GARDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-3342
Mailing Address - Country:US
Mailing Address - Phone:904-442-1003
Mailing Address - Fax:
Practice Address - Street 1:213 GARDEN LAKE DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-3342
Practice Address - Country:US
Practice Address - Phone:904-442-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-08
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212815224Z00000X
FLOTA13609224Z00000X
GAOTA002149224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant