Provider Demographics
NPI:1568602092
Name:DOMBROWSKI, PATRICIA R (OTR)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:R
Last Name:DOMBROWSKI
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:PO BOX 422
Mailing Address - Street 2:3381 RT 23A
Mailing Address - City:PALENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12463-0422
Mailing Address - Country:US
Mailing Address - Phone:518-678-3540
Mailing Address - Fax:
Practice Address - Street 1:3381 RT 23A
Practice Address - Street 2:
Practice Address - City:PALENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12463-0422
Practice Address - Country:US
Practice Address - Phone:518-678-3540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073542146N00000X
NY4828-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic