Provider Demographics
NPI:1104073956
Name:DOMZALSKI, ERIN MARGARET (DT)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:MARGARET
Last Name:DOMZALSKI
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 STEFANIE LN
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-9646
Mailing Address - Country:US
Mailing Address - Phone:815-953-6163
Mailing Address - Fax:
Practice Address - Street 1:1664 STEFANIE LN
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9646
Practice Address - Country:US
Practice Address - Phone:815-953-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2008-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist