Provider Demographics
NPI:1265728091
Name:O'NEILL, KERRY (PT, MHA)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PT, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OXBOW DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-5075
Mailing Address - Country:US
Mailing Address - Phone:774-254-0087
Mailing Address - Fax:
Practice Address - Street 1:188 WASHINGTON ST UNIT 3
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-1301
Practice Address - Country:US
Practice Address - Phone:508-699-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9983225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist