Provider Demographics
NPI:1003500448
Name:DOMMEL, MADELINE ROSE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:ROSE
Last Name:DOMMEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 POND HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5203
Mailing Address - Country:US
Mailing Address - Phone:203-903-3629
Mailing Address - Fax:
Practice Address - Street 1:469 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3400
Practice Address - Country:US
Practice Address - Phone:203-828-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6213225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics