Healthcare Provider Details

I. General information

NPI: 1174972830
Provider Name (Legal Business Name): ERICA A LOPEZ O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA A BROOKS

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 COMMERCIAL CENTER DR
LADSON SC
29456-4146
US

IV. Provider business mailing address

407 CHURCH ST. SUITEE
GEORGETOWN SC
29440
US

V. Phone/Fax

Practice location:
  • Phone: 843-314-5434
  • Fax:
Mailing address:
  • Phone: 843-545-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4694
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: