Provider Demographics
NPI:1063705184
Name:LEMIEUX, DOMINIQUE MARGARET (OTR/L)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MARGARET
Last Name:LEMIEUX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 DIVOT DR
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8870
Mailing Address - Country:US
Mailing Address - Phone:425-765-4589
Mailing Address - Fax:
Practice Address - Street 1:1509 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4568
Practice Address - Country:US
Practice Address - Phone:360-736-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60215181225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist