Provider Demographics
NPI:1750701694
Name:MCNEIL, MOLLY GAIL (MED, ATC, OTC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:GAIL
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:MED, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DEPT OF ORTHOPAEDICS 3D
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-7307
Mailing Address - Fax:603-650-0725
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DEPT OF ORTHOPAEDICS 3D
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-7307
Practice Address - Fax:603-650-0725
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-18
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH05792255A2300X
246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other