Provider Demographics
NPI:1528397999
Name:O'NEIL, AMY REBECCA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:REBECCA
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:REBECCA
Other - Last Name:WISNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:11623 ARBOR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2981
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4674 40TH AVE S STE A
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4501
Practice Address - Country:US
Practice Address - Phone:701-293-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000857224Z00000X
ND1366225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant