MEDICARE: KRISTEN O'NEIL

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	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1083014708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN O'NEIL

Provider Business Mailing Address
First Line	:	40 POSTAL ST
Second Line	:
City	:	PROCTOR
State	:	WV
Zip	:	26055-1316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 POSTAL ST
Second Line	:
City	:	PROCTOR
State	:	WV
Zip	:	26055-1316
Country	:	US
Telephone Number	:	304-771-4082
Fax Number	:

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

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	08/29/2014

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Directions to “ KRISTEN O'NEIL ” Practice Location

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