Individual
DOMINIQUE OLDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
8950 COACHLIGHT DR, WEST DES MOINES, IA 50266-8778
(515) 375-2100
Mailing address
14605 E 257TH AVE, EAGLEVILLE, MO 64442-9137
(515) 771-8379
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
085075
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
11/30/2021
Last updated
12/13/2021
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