Provider Demographics
NPI:1285271486
Name:DOCKINS, DOMINIQUE
Entity type:Individual
Prefix:MISS
First Name:DOMINIQUE
Middle Name:
Last Name:DOCKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SUMMIT VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158
Mailing Address - Country:US
Mailing Address - Phone:443-789-1225
Mailing Address - Fax:
Practice Address - Street 1:475 SUMMIT VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158
Practice Address - Country:US
Practice Address - Phone:443-789-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program