Individual
MICHELLE DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
10201 S CICERO AVE STE A, OAK LAWN, IL 60453-4672
(708) 658-2770
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056-013271
IL
Other
Enumeration date
09/06/2024
Last updated
10/16/2024
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