Healthcare Provider Details

I. General information

NPI: 1023859907
Provider Name (Legal Business Name): KATHRYN O'NEIL LAT, ATC, EMT-B, CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 OLD WESTPORT RD
NORTH DARTMOUTH MA
02747-2356
US

IV. Provider business mailing address

5500 N MAIN ST APT 102
FALL RIVER MA
02720-2061
US

V. Phone/Fax

Practice location:
  • Phone: 508-999-8000
  • Fax:
Mailing address:
  • Phone: 339-832-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberATL23252
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: