Individual
DINA DOMINQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1302 TOM TEMPLE DR, LUFKIN, TX 75904-5581
(936) 634-0490
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210344
TX
Other
Enumeration date
01/14/2011
Last updated
01/14/2011
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