Provider Demographics
NPI:1649400169
Name:O'NEILL, KENNETH GERARD (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:GERARD
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 CLAREMONT WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3329
Mailing Address - Country:US
Mailing Address - Phone:707-259-1152
Mailing Address - Fax:707-259-1361
Practice Address - Street 1:3273 CLAREMONT WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3306
Practice Address - Country:US
Practice Address - Phone:707-259-1152
Practice Address - Fax:707-259-1361
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT1808225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand