Provider Demographics
NPI:1306275698
Name:O'NEILL, JOHN JR
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:O'NEILL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 ERVA ST
Mailing Address - Street 2:APT 165
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6300
Mailing Address - Country:US
Mailing Address - Phone:702-633-5096
Mailing Address - Fax:
Practice Address - Street 1:3450 ERVA ST
Practice Address - Street 2:APT 165
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-6300
Practice Address - Country:US
Practice Address - Phone:702-633-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor