Individual
THERESA MAE DOMINICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1001 6TH AVE, SUITE 240, LEAVENWORTH, KS 66048-3222
(913) 682-6103
Mailing address
710 DEERFIELD ST, LEAVENWORTH, KS 66048-5541
(913) 775-3101
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
17-02236
KS
Other
Enumeration date
04/30/2013
Last updated
04/30/2013
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