Individual
MS. BRENDA LEE DOMINGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2008 36TH STREET UNIT B, MISSOULA, MT 59801
(509) 701-5295
Mailing address
2008 36TH STREET UNIT B, MISSOULA, MT 59801
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
937
MT
Other
Enumeration date
09/25/2009
Last updated
09/25/2009
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