Provider Demographics
NPI:1811475767
Name:O'NEIL, MICHAELA MEGHAN (DPT)
Entity type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:MEGHAN
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1452
Mailing Address - Country:US
Mailing Address - Phone:617-797-3973
Mailing Address - Fax:
Practice Address - Street 1:520 WEST AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-4034
Practice Address - Country:US
Practice Address - Phone:203-852-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11930OtherDEPARTMENT OF PUBLIC HEALTH