MEDICARE: KATHRYN O'NEIL

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
1	2255A2300X	Athletic Trainer
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1023859907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN O'NEIL

Provider Business Mailing Address
First Line	:	3 COPPER BEECH DR
Second Line	:
City	:	KINGSTON
State	:	MA
Zip	:	02364-2180
Country	:	US
Telephone Number	:	339-832-4562
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 STANLEY ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06053-2490
Country	:	US
Telephone Number	:	339-832-4562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	06/04/2024

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