Provider Demographics
NPI:1356665228
Name:VANLITH, DOMINIC MARINUS (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:MARINUS
Last Name:VANLITH
Suffix:
Gender:M
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 1:6633 CHRISTY CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9127
Mailing Address - Country:US
Mailing Address - Phone:503-999-3610
Mailing Address - Fax:
Practice Address - Street 1:6633 CHRISTY CT SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-9127
Practice Address - Country:US
Practice Address - Phone:503-999-3610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR982501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist