Individual
DOMINIQUE JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
412 LONGVIEW DR, BELLEVILLE, IL 62223-4135
(618) 960-7414
Mailing address
412 LONGVIEW DR, BELLEVILLE, IL 62223-4135
(618) 960-7414
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2021031173
MO
Other
Enumeration date
07/09/2022
Last updated
07/09/2022
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