Provider Demographics
NPI:1184447971
Name:A. DOMINGUEZ OTR, PC
Entity type:Organization
Organization Name:A. DOMINGUEZ OTR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:832-818-4206
Mailing Address - Street 1:6407 PORTUGUESE BEND DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5027
Mailing Address - Country:US
Mailing Address - Phone:832-818-4206
Mailing Address - Fax:
Practice Address - Street 1:6407 PORTUGUESE BEND DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5027
Practice Address - Country:US
Practice Address - Phone:832-818-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty