Individual
DOMINADOR RANDY BURTANOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
27 COURTNEY ST, APT. 8, FALL RIVER, MA 02720-6706
(401) 316-4201
Mailing address
27 COURTNEY ST, APT. 8, FALL RIVER, MA 02720-6706
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
8619
MA
Other
Enumeration date
04/08/2013
Last updated
04/08/2013
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