Healthcare Provider Details

I. General information

NPI: 1265867717
Provider Name (Legal Business Name): TIMOTHY O'NEILL EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 NW 6TH AVE
PORTLAND OR
97209-3609
US

IV. Provider business mailing address

1535 N WILLIAMS AVE
PORTLAND OR
97227-1885
US

V. Phone/Fax

Practice location:
  • Phone: 503-294-1681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number142377
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: