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General NPI Number Information
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NPI Number | 1649394099
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Entity Type | Individual
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Provider Name | ALEJANDRO DOMINGO SMALL OTRL
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6200 OREGON AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20015-1543
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Country | US
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Telephone | 202-541-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 1743 HAMPTON CT
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City | BONITA
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State | CA
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Zip | 91902-4011
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Country | US
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Telephone | 909-374-0001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 05746
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT010000400
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT4122
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0119004495
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License Number State | VA
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