Healthcare Provider Details

I. General information

NPI: 1114313509
Provider Name (Legal Business Name): MARITESS LOPEZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 COASTAL HWY
ST AUGUSTINE FL
32084-1302
US

IV. Provider business mailing address

201 S MAIN ST BUILDING A LOFT
LAMBERTVILLE NJ
08530-1800
US

V. Phone/Fax

Practice location:
  • Phone: 201-918-9269
  • Fax:
Mailing address:
  • Phone: 352-445-1489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number46TR00398300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT25399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: