Provider Demographics
NPI:1164628517
Name:DOMKA, TAMARA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:DOMKA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SNYDER RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:OH
Mailing Address - Zip Code:44822-9691
Mailing Address - Country:US
Mailing Address - Phone:419-631-8121
Mailing Address - Fax:
Practice Address - Street 1:105 N MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44902-7669
Practice Address - Country:US
Practice Address - Phone:419-522-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH005027225X00000X, 225XE1200X, 225XH1300X, 225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No225XH1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHuman Factors
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation