Provider Demographics
NPI:1164895785
Name:BOSTIC-ARRINGTON, DOMINIQUE (OTR/L)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:BOSTIC-ARRINGTON
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 1:11312 KEMPSFORD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2528
Mailing Address - Country:US
Mailing Address - Phone:704-562-2505
Mailing Address - Fax:
Practice Address - Street 1:2675 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054
Practice Address - Country:US
Practice Address - Phone:704-824-7800
Practice Address - Fax:704-824-2822
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16741225X00000X
NC10065225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist