Individual
DOMINIQUE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2201 MOUNT ZION PKWY, MORROW, GA 30260-3312
(844) 543-8437
Mailing address
2201 MOUNT ZION PKWY, MORROW, GA 30260-3312
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598046245
—
GA
Enumeration date
08/09/2022
Last updated
08/09/2022
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