MEDICARE: SUSAN L O'NEAL LMT

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	225700000X	Massage Therapist	MA33819	FL

General Provider Information

NPI Number	:	1366500365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L O'NEAL LMT

Provider Business Mailing Address
First Line	:	1221 CAMBRIDGE RD
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-3563
Country	:	US
Telephone Number	:	407-421-7859
Fax Number	:	407-622-6244

Provider Business Practice Location Address
First Line	:	1435 HOWELL BRANCH RD
Second Line	:	SUITE E.
City	:	WINTER PARK
State	:	FL
Zip	:	32789-1157
Country	:	US
Telephone Number	:	407-622-6244
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN L O'NEAL LMT” Practice Location

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