Provider Demographics
NPI:1619333473
Name:O'NEILL, KIM-MARIE (OT)
Entity Type:Individual
Prefix:MRS
First Name:KIM-MARIE
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MILL ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3214
Mailing Address - Country:US
Mailing Address - Phone:508-221-6707
Mailing Address - Fax:
Practice Address - Street 1:678 DEPOT ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-2704
Practice Address - Country:US
Practice Address - Phone:508-221-6707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-10
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4081225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist