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NPI Code Detail

MEDICARE: MR. KEVIN PETER O'NEILL M.S., A.T.C.

MEDICARE: MR. KEVIN PETER O'NEILL M.S., A.T.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerAL 541FL

General Provider Information

NPI Number : 1023135308
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN PETER O'NEILL M.S., A.T.C.
Provider Business Mailing Address
First Line : 7500 SW 30TH ST
Second Line :
City : DAVIE
State : FL
Zip : 33314-1020
Country : US
Telephone Number : 954-452-7030
Fax Number : 954-452-7069
Provider Business Practice Location Address
First Line : 7500 SW 30TH ST
Second Line :
City : DAVIE
State : FL
Zip : 33314-1020
Country : US
Telephone Number : 954-452-7030
Fax Number : 954-452-7069
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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