Individual
MICHELLE LYNN DOMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA/L
Contact information
Practice address
189 ALPS RD, BRANFORD, CT 06405-4771
(203) 315-2615
Mailing address
189 ALPS RD, BRANFORD, CT 06405-4771
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
001534
CT
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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