MEDICARE: JOSEPH P MCNEIL O.T.

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	225X00000X	Occupational Therapist	106281	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	106281	OTHER	TX	LICENSE

General Provider Information

NPI Number	:	1922245588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH P MCNEIL O.T.

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:
City	:	GROESBECK
State	:	TX
Zip	:	76642-0308
Country	:	US
Telephone Number	:	254-729-5317
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 S BUCKNER BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-2373
Country	:	US
Telephone Number	:	214-381-7700
Fax Number	:

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

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/19/2009

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