NPI 1033418645

Mary Domhan, COTA

Practitioner Contractor Chesterfield, VA

Practice location

Address: 6800 Lucy Corr Blvd, Chesterfield, VA 23832
Phone: (804) 706-5648
Mailing address: 2819 Jeffers Dr, North Chesterfield, VA 23235-2439

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 0131001557 (VA)

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Registry record

NPI: 1033418645
Entity type: Individual
Sex (as registered): Female
NPI issued: 22 Mar 2011
Record last updated: 20 Mar 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.