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General NPI Number Information
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NPI Number | 1518343953
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Entity Type | Individual
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Provider Name | ERIC MCNEIL
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Gender | Male
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Dates
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Enumeration Date | 08/08/2015
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 213 GARDEN LAKE DR
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City | RIVERDALE
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State | GA
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Zip | 30296-3342
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Country | US
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Telephone | 904-442-1003
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Fax |
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Provider Business Mailing Address
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Address Line | 213 GARDEN LAKE DR
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City | RIVERDALE
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State | GA
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Zip | 30296-3342
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Country | US
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Telephone | 904-442-1003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 212815
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA13609
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA002149
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License Number State | GA
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