Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 18-00895 | KS |
N | 224Z00000X | Occupational Therapy Assistant | 2013009029 | MO |
NPI | 1023453073 |
---|---|
Provider Name | Socorro Liliana Lopez-Goldstein |
First Address | Overland Park, KS 66213-5134 |
Second Address | Merriam, KS 66204-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2013 |
Last Update Date | 03/05/2013 |