Provider Demographics
NPI:1124359849
Name:O'NEILL, CELESTE LOVELAND (KT, CWK)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:LOVELAND
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:KT, CWK
Other - Prefix:MISS
Other - First Name:CELESTE
Other - Middle Name:LOVELAND
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2600 MARY ELLEN ST. NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1438
Mailing Address - Country:US
Mailing Address - Phone:505-271-1010
Mailing Address - Fax:505-271-1010
Practice Address - Street 1:2600 MARY ELLEN ST. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1438
Practice Address - Country:US
Practice Address - Phone:505-271-1010
Practice Address - Fax:505-271-1010
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11192000172M00000X, 225500000X
1119200226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No172M00000XOther Service ProvidersMechanotherapist
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist