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Individual

JENICA E DOMANICO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, OTR/L

Contact information

Practice address
5842 HOBE LN, WHITE BEAR LAKE, MN 55110-6477
(651) 383-1197
Mailing address
5842 HOBE LN, WHITE BEAR LAKE, MN 55110-6477
(651) 383-1197

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
104260
MN

Other

Enumeration date
07/25/2012
Last updated
12/13/2018
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