Provider Demographics
NPI:1831642685
Name:BROTMAN DOMORACKI, SANDRA (AUD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:BROTMAN DOMORACKI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 NORTHWEST AVE
Mailing Address - Street 2:A
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1832
Mailing Address - Country:US
Mailing Address - Phone:330-633-2055
Mailing Address - Fax:330-633-2658
Practice Address - Street 1:143 NORTHWEST AVE
Practice Address - Street 2:A
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1832
Practice Address - Country:US
Practice Address - Phone:330-633-2055
Practice Address - Fax:330-633-2658
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00332231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist