Individual
MR. ANDRE DIVINE DOMINGOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17420 GALLAGHER WAY, OLNEY, MD 20832-2059
(240) 377-1700
Mailing address
17420 GALLAGHER WAY, OLNEY, MD 20832-2059
(240) 377-1700
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A02204
MD
Other
Enumeration date
05/20/2016
Last updated
05/20/2016
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