Provider Demographics
NPI:1811442676
Name:O'NEILL, COLLEEN MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-5802
Mailing Address - Country:US
Mailing Address - Phone:718-254-0800
Mailing Address - Fax:718-254-0888
Practice Address - Street 1:532 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-5802
Practice Address - Country:US
Practice Address - Phone:718-254-0800
Practice Address - Fax:718-254-0888
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020833-1225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics