Provider Demographics
NPI:1982772489
Name:MCNEILY, DEE A (OPT)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:A
Last Name:MCNEILY
Suffix:
Gender:F
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1742
Mailing Address - Country:US
Mailing Address - Phone:270-796-4698
Mailing Address - Fax:270-782-3247
Practice Address - Street 1:165 NATCHEZ TRACE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7947
Practice Address - Country:US
Practice Address - Phone:270-796-4698
Practice Address - Fax:270-782-3247
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2019-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY131115225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1760411342OtherGROUP NPI
KYGROUP #91011148Medicaid
KYGROUP # 184501Medicare ID - Type Unspecified