Individual
MR. DOMANIQUE CODY FORBES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, OTR/L
Contact information
Practice address
2560 N TEXAS ST STE J, FAIRFIELD, CA 94533-1649
(707) 330-6949
(707) 425-2543
Mailing address
3700 LYON RD APT 227, FAIRFIELD, CA 94534-7984
(423) 677-8615
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
19962
CA
Other
Enumeration date
05/02/2019
Last updated
05/02/2019
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