MEDICARE: JOHN O'NEILL JR.

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	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1306275698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN O'NEILL JR.

Provider Business Mailing Address
First Line	:	3450 ERVA ST
Second Line	:	APT 165
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6300
Country	:	US
Telephone Number	:	702-633-5096
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 ERVA ST
Second Line	:	APT 165
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6300
Country	:	US
Telephone Number	:	702-633-5096
Fax Number	:

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

Provider Enumeration Date	:	11/06/2013
Last Update Date	:	11/06/2013

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