Provider Demographics
NPI:1174159966
Name:CRICI, DOMINIC JOHN (OTR/L)
Entity type:Individual
Prefix:
First Name:DOMINIC
Middle Name:JOHN
Last Name:CRICI
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 SW 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6127
Mailing Address - Country:US
Mailing Address - Phone:516-817-8084
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 36TH ST STE 18
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6661
Practice Address - Country:US
Practice Address - Phone:786-350-8327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20754225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist