Provider Demographics
NPI:1851711162
Name:ONEIL, ERICA (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:
Last Name:ONEIL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 COOKS BAY CT
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1612
Mailing Address - Country:US
Mailing Address - Phone:410-721-1171
Mailing Address - Fax:
Practice Address - Street 1:310 GENESIS WAY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1762
Practice Address - Country:US
Practice Address - Phone:410-544-4220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19592225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist