Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT17651 | FL |
N | 225XH1200X | Occupational Therapist - Hand | OT17651 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT17651 | FL |
NPI | 1215449103 |
---|---|
Provider Name | Kevin Matthew Lopez |
First Address | Miami, FL 33132-2294 |
Second Address | Sunny Isles Beach, FL 33160-2722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2017 |
Last Update Date | 31/10/2017 |