Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT006916 | GA |
NPI | 1003489048 |
---|---|
Provider Name | Keisy Arislu Lopez-Lomeli |
First Address | Mableton, GA 30126-1177 |
Second Address | Lithia Springs, GA 30122-1589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2021 |
Last Update Date | 19/07/2021 |