Individual
AMANDA NICOLE DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12750 SW 128TH ST, MIAMI, FL 33186-5379
(786) 646-0091
Mailing address
15222 SW 115TH TER # 33196, MIAMI, FL 33196-5218
(305) 282-9811
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
17486
FL
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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