Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1359 | MA |
NPI | 1033393509 |
---|---|
Provider Name | Mrs. Mercedes M Lopez |
First Address | Somerville, MA 02143-3421 |
Second Address | Somerville, MA 02143-3421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2007 |
Last Update Date | 20/12/2007 |