Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 22700 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 22700 | FL |
NPI | 1013660521 |
---|---|
Provider Name | Jasmine Lopez |
First Address | Lutz, FL 33558-4953 |
Second Address | Lutz, FL 33558-4953 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2022 |
Last Update Date | 03/02/2022 |