Individual
KATHIE DOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
314 E CARDINAL ST, SPRINGFIELD, MO 65810-1734
(417) 234-7235
(417) 823-9937
Mailing address
314 E CARDINAL ST, SPRINGFIELD, MO 65810-1734
(417) 234-7235
(417) 823-9937
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2005018686
MO
Other
Enumeration date
05/19/2010
Last updated
05/19/2010
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