MEDICARE: MISS STEPHANIE O'NEILL CF-SLP

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1215315056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS STEPHANIE O'NEILL CF-SLP

Provider Business Mailing Address
First Line	:	30 WASHINGTON ST
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 WASHINGTON ST
Second Line	:
City	:	WELLESLEY HILLS
State	:	MA
Zip	:	02481-1905
Country	:	US
Telephone Number	:	978-996-3799
Fax Number	:

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

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	05/13/2015

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