Provider Demographics
NPI:1790937944
Name:O'NEIL, KELLY M (COTA/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:BOLLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:7 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:NY
Mailing Address - Zip Code:14011-1208
Mailing Address - Country:US
Mailing Address - Phone:585-721-0056
Mailing Address - Fax:
Practice Address - Street 1:7 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1208
Practice Address - Country:US
Practice Address - Phone:585-721-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004321224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant