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Individual

MS. HANNAH JEAN MENDEZ DOMINGUEZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
801 BRIM ST, DESLOGE, MO 63601-3441
(573) 431-0223
Mailing address
400 MAPLE VALLEY DR, APT 6, FARMINGTON, MO 63640-1979
(417) 434-1344

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2005032610
MO

Other

Enumeration date
02/22/2007
Last updated
07/08/2007
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