Individual
DOMINIQUE NICOLE LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
176 W UNIVERSITY PKWY STE E, JACKSON, TN 38305-1618
(313) 004-9507
(731) 300-4951
Mailing address
7001A LOISDALE RD, SPRINGFIELD, VA 22150-1904
(703) 971-0602
(703) 971-0606
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
0119007097
MD
Other
Enumeration date
09/19/2016
Last updated
10/22/2023
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