Individual
MS. DOMINIQUE DENIECE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
506 VAN NESS ST, WINTERS, TX 79567-4724
(325) 754-4566
Mailing address
610 E AVENUE D, SAN ANGELO, TX 76903-7143
(954) 513-7130
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211177
TX
Other
Enumeration date
08/29/2018
Last updated
08/29/2018
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