Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 005027 | OH |
N | 2251E1200X | Ergonomics | 005027 | OH |
N | 225XE1200X | Ergonomics | 005027 | OH |
N | 2251H1300X | Human Factors | 005027 | OH |
N | 225XH1300X | Human Factors | 005027 | OH |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 005027 | OH |
NPI | 1164628517 |
---|---|
Provider Name | Mrs. Tamara Domka |
First Address | Butler, OH 44822-9691 |
Second Address | Mansfield, OH 44902-7669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 10/08/2012 |