MEDICARE: KELLY O'NEIL PT

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	225100000X	Physical Therapist	1242	NH

General Provider Information

NPI Number	:	1912455940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY O'NEIL PT

Provider Business Mailing Address
First Line	:	15 MAROIS AVE
Second Line	:
City	:	GORHAM
State	:	NH
Zip	:	03581-1108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	364 CATES HILL RD
Second Line	:
City	:	BERLIN
State	:	NH
Zip	:	03570-1554
Country	:	US
Telephone Number	:	603-752-2343
Fax Number	:

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

Provider Enumeration Date	:	09/20/2016
Last Update Date	:	09/20/2016

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Directions to “ KELLY O'NEIL PT” Practice Location

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