Provider Demographics
NPI:1902396963
Name:GARCIA, DOMINIQUE (COTA/L)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329 NW 179TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4450
Mailing Address - Country:US
Mailing Address - Phone:786-281-8670
Mailing Address - Fax:
Practice Address - Street 1:14411 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1596
Practice Address - Country:US
Practice Address - Phone:305-625-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA16512224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant