Healthcare Provider Details

I. General information

NPI: 1962669564
Provider Name (Legal Business Name): MARY T O'NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 W IRON SPRINGS RD SUITE 11
PRESCOTT AZ
86305-1394
US

IV. Provider business mailing address

323 FOREST HILLS CIR
PRESCOTT AZ
86303-5515
US

V. Phone/Fax

Practice location:
  • Phone: 928-713-0071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0499
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: