Provider Demographics
NPI:1154795805
Name:O'NEILL, OLIVIA ANNA CAMILLA (PTA)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ANNA CAMILLA
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 S FALLSMEAD WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2640
Mailing Address - Country:US
Mailing Address - Phone:301-980-5323
Mailing Address - Fax:
Practice Address - Street 1:3227 BEL PRE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2423
Practice Address - Country:US
Practice Address - Phone:301-871-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15-043310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility