Provider Demographics
NPI:1205105749
Name:DEWITT, CYNTHIA DOMINGUE (OTR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DOMINGUE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 WILD ONION DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-7013
Mailing Address - Country:US
Mailing Address - Phone:512-241-9635
Mailing Address - Fax:
Practice Address - Street 1:7600 WILD ONION DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-7013
Practice Address - Country:US
Practice Address - Phone:512-241-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119006160225X00000X
PAOC012303225X00000X
UT8877038-4201225X00000X
CA15221225X00000X
NC10035225X00000X
MA12197225X00000X
TX111251225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist