MEDICARE: ROBIN SUSAN O'NEAL

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1902131089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN SUSAN O'NEAL

Provider Business Mailing Address
First Line	:	3926 VINEYARD GREEN DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-5229
Country	:	US
Telephone Number	:	513-528-1757
Fax Number	:

Provider Business Practice Location Address
First Line	:	3926 VINEYARD GREEN DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-5229
Country	:	US
Telephone Number	:	513-528-1757
Fax Number	:

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

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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