Provider Demographics
NPI:1710585799
Name:O'NEIL, BRITTANY MONIQUE (LMT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MONIQUE
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LAVENDER
Other - Middle Name:MONIQUE
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:94 W HURLEY RD APT 4
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1849
Mailing Address - Country:US
Mailing Address - Phone:845-681-9881
Mailing Address - Fax:
Practice Address - Street 1:94 W HURLEY RD APT 4
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1849
Practice Address - Country:US
Practice Address - Phone:845-681-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist