Provider Demographics
NPI:1396038790
Name:JOSEPH, DOMINIC (MOT, MBA, COMT, CHT)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MOT, MBA, COMT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 GENOVA WAY LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1165
Mailing Address - Country:US
Mailing Address - Phone:281-380-4340
Mailing Address - Fax:
Practice Address - Street 1:3221 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4366
Practice Address - Country:US
Practice Address - Phone:281-916-6575
Practice Address - Fax:281-916-6585
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111441225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist