Provider Demographics
NPI:1740309749
Name:DOMSIC, JUDY LEE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LEE
Last Name:DOMSIC
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8646 WOODLANDS CT
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9751
Mailing Address - Country:US
Mailing Address - Phone:614-759-7815
Mailing Address - Fax:
Practice Address - Street 1:2000 REGENCY MANOR CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1777
Practice Address - Country:US
Practice Address - Phone:614-445-8261
Practice Address - Fax:614-445-8050
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-2803225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist