Provider Demographics
NPI:1598967226
Name:DOMINGUEZ, MARISOL
Entity Type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARISOL
Other - Middle Name:ORTIZ
Other - Last Name:BELTRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTRL
Mailing Address - Street 1:10251 HUNTINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-2574
Mailing Address - Country:US
Mailing Address - Phone:144-057-2342
Mailing Address - Fax:
Practice Address - Street 1:6455 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2984
Practice Address - Country:US
Practice Address - Phone:440-887-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT01360225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist