Provider Demographics
NPI:1265990378
Name:O'NEILL, KATHERINE MICHELE (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:MICHELE
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2140 CLANCY CT
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-6292
Mailing Address - Country:US
Mailing Address - Phone:805-300-4403
Mailing Address - Fax:
Practice Address - Street 1:2140 CLANCY CT
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6292
Practice Address - Country:US
Practice Address - Phone:805-300-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38089225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT38089OtherSTATE LICENSE