Individual
MARIA LORENA DOMINGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4616 NE STALLINGS DR, NACOGDOCHES, TX 75965-1608
(936) 569-5600
Mailing address
3328 COUNTY ROAD 273, GARRISON, TX 75946-7407
(936) 645-0357
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210754
TX
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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