Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212101 | TX |
NPI | 1023599164 |
---|---|
Provider Name | Vanessa Renee Lopez |
First Address | Fredericksburg, TX 78624-4408 |
Second Address | Fredericksburg, TX 78624-4408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |