Provider Demographics
NPI:1164443065
Name:O'NEILL, SARA MARIE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:ADAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:3811 29TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-1280
Mailing Address - Country:US
Mailing Address - Phone:308-233-5060
Mailing Address - Fax:308-233-5062
Practice Address - Street 1:3811 29TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-1280
Practice Address - Country:US
Practice Address - Phone:308-233-5060
Practice Address - Fax:308-233-5062
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025290100Medicaid
NEQ31483Medicare UPIN
NE278374Medicare ID - Type Unspecified