Healthcare Provider Details

I. General information

NPI: 1598297095
Provider Name (Legal Business Name): TINA O'NEILL L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 FRUITVALE BLVD APT 112
YAKIMA WA
98902-7328
US

IV. Provider business mailing address

2502 FRUITVALE BLVD APT 112
YAKIMA WA
98902-7328
US

V. Phone/Fax

Practice location:
  • Phone: 206-802-8564
  • Fax:
Mailing address:
  • Phone: 206-802-8564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number00020298
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: