MEDICARE: DIANE K O'NEIL OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	00002553	CO

General Provider Information

NPI Number	:	1003047655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE K O'NEIL OTR/L

Provider Business Mailing Address
First Line	:	202 WEST AVE
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-2156
Country	:	US
Telephone Number	:	719-298-1652
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 WEST AVE
Second Line	:
City	:	ALAMOSA
State	:	CO
Zip	:	81101-2156
Country	:	US
Telephone Number	:	719-298-1652
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	11/29/2016

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