Provider Demographics
NPI:1811211865
Name:DOMIANO, JENNY DORRIS (MOT, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:DORRIS
Last Name:DOMIANO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 CLEARY AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2625
Mailing Address - Country:US
Mailing Address - Phone:504-831-2321
Mailing Address - Fax:504-831-8388
Practice Address - Street 1:1817 CLEARY AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2625
Practice Address - Country:US
Practice Address - Phone:504-831-2321
Practice Address - Fax:504-831-8388
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11942225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics