Provider Demographics
NPI:1265720882
Name:ONEILL, DEVON RAE (DPT)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:RAE
Last Name:ONEILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DEVON
Other - Middle Name:RAE
Other - Last Name:DOUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:465 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2613
Mailing Address - Country:US
Mailing Address - Phone:203-879-0107
Mailing Address - Fax:203-879-0206
Practice Address - Street 1:465 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2613
Practice Address - Country:US
Practice Address - Phone:203-879-0107
Practice Address - Fax:203-879-0206
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist