Individual
DOMENIQUE MCMAHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTAL
Contact information
Practice address
3012 HOLBEN CT, LAKE ORION, MI 48360-1671
(586) 854-9874
Mailing address
3012 HOLBEN CT, LAKE ORION, MI 48360-1671
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5202008445
MI
224Z00000X
Occupational Therapy Assistant
—
—
Other
Enumeration date
09/08/2020
Last updated
09/11/2020
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