Provider Demographics
NPI:1952531774
Name:DOMIJAN, VINCENZA (MOT,OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:VINCENZA
Middle Name:
Last Name:DOMIJAN
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 1:915 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3921
Mailing Address - Country:US
Mailing Address - Phone:860-704-4000
Mailing Address - Fax:
Practice Address - Street 1:915 RIVER RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3921
Practice Address - Country:US
Practice Address - Phone:860-704-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003946225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist