Provider Demographics
NPI:1629688353
Name:O'NEILL, KATLYN ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ELIZABETH
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 TAPESTRY CIR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-8372
Mailing Address - Country:US
Mailing Address - Phone:740-285-3235
Mailing Address - Fax:
Practice Address - Street 1:1050 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9075
Practice Address - Country:US
Practice Address - Phone:812-951-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013820A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist