Healthcare Provider Details

I. General information

NPI: 1265105845
Provider Name (Legal Business Name): TOM MCNEELY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N GRAY ST
KILLEEN TX
76541-5245
US

IV. Provider business mailing address

316 N GRAY ST
KILLEEN TX
76541-5245
US

V. Phone/Fax

Practice location:
  • Phone: 419-618-1135
  • Fax:
Mailing address:
  • Phone: 419-618-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: