Individual
JENIE DOMANGUE
Active
Individual
JENIE DOMANGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOTR
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OTT.Z11092
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1623121
—
LA
Enumeration date
03/13/2007
Last updated
07/09/2007
Update your record
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