Provider Demographics
NPI:1386224145
Name:O'NEILL, MARTHA (MS, RD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 MARSEILLE PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5534
Mailing Address - Country:US
Mailing Address - Phone:847-302-9698
Mailing Address - Fax:
Practice Address - Street 1:1519 MARSEILLE PL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5534
Practice Address - Country:US
Practice Address - Phone:847-302-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86209584133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered