Healthcare Provider Details

I. General information

NPI: 1346017746
Provider Name (Legal Business Name): LIZETTE YVONNE LOPEZ OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23909 W RENWICK RD STE 105
PLAINFIELD IL
60544-2109
US

IV. Provider business mailing address

8201 CASS AVE
DARIEN IL
60561-5314
US

V. Phone/Fax

Practice location:
  • Phone: 779-234-9583
  • Fax:
Mailing address:
  • Phone: 630-590-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056015605
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: