Individual
DOMINIKA J PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
2579 OCEAN AVE FL 3, BROOKLYN, NY 11229-4552
(732) 766-8945
Mailing address
11 LISA ROBYN CIR APT 101, LAKEWOOD, NJ 08701-7018
(732) 766-8945
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00863800
NJ
225X00000X
Occupational Therapist
—
—
Other
Enumeration date
03/13/2019
Last updated
10/30/2019
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