Individual
BETHANY DOMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
210 DEMPSEY RD, MADISON, WI 53714
(815) 355-9999
Mailing address
210 DEMPSEY RD, MADISON, WI 53714-3006
(815) 355-9999
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5855-26
WI
Other
Enumeration date
05/31/2016
Last updated
11/13/2019
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