Provider Demographics
NPI:1588146575
Name:DIONNE, DOMINIQUE (COTA/L)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:DIONNE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 1/2 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3333
Mailing Address - Country:US
Mailing Address - Phone:207-241-0157
Mailing Address - Fax:207-753-3003
Practice Address - Street 1:984 1/2 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3333
Practice Address - Country:US
Practice Address - Phone:207-241-0157
Practice Address - Fax:207-753-3003
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOA3378224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant