Basic Information
| Provider Information | |||||||||
| NPI: | 1063705184 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEMIEUX | ||||||||
| FirstName: | DOMINIQUE | ||||||||
| MiddleName: | MARGARET | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 DIVOT DR | ||||||||
| Address2: | |||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985328870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257654589 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1509 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | CENTRALIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985314568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607360112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2011 | ||||||||
| LastUpdateDate: | 05/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT60215181 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.