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General NPI Number Information
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NPI Number | 1720255201
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Entity Type | Individual
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Provider Name | JEREMY C DOMINA OTR
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Gender | Male
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 49 LYME RD
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City | HANOVER
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State | NH
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Zip | 03755-1205
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Country | US
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Telephone | 603-643-2854
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Fax |
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Provider Business Mailing Address
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Address Line | 227 OLD ROUTE 15
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City | CAMBRIDGE
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State | VT
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Zip | 05444-9772
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Country | US
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Telephone | 802-310-1511
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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 | 1702
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License Number State | NH
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