Individual
DOMINIQUE LATOYA PROPHET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3767 DELAWARE AVE, KENMORE, NY 14217-1040
(716) 874-6175
Mailing address
227 VINE LN, BUFFALO, NY 14228-1845
(716) 544-8758
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Enumeration date
07/08/2024
Last updated
07/08/2024
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