Provider Demographics
NPI:1033772942
Name:GROSSMAN, DOMINIQUE AIDA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:AIDA
Last Name:GROSSMAN
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 1:4495 HALE PKWY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-6210
Mailing Address - Country:US
Mailing Address - Phone:844-757-7450
Mailing Address - Fax:855-715-3504
Practice Address - Street 1:4495 HALE PKWY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-6210
Practice Address - Country:US
Practice Address - Phone:844-757-7450
Practice Address - Fax:855-715-3504
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics