Healthcare Provider Details

I. General information

NPI: 1912859513
Provider Name (Legal Business Name): BETHANNIE NICOLE LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E 11TH AVE STE LL2
EUGENE OR
97401-3601
US

IV. Provider business mailing address

1485 JOHN DAY DR UNIT 204
COBURG OR
97408-6021
US

V. Phone/Fax

Practice location:
  • Phone: 541-359-1009
  • Fax:
Mailing address:
  • Phone: 541-359-1009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number546669
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: