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General NPI Number Information
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NPI Number | 1366203556
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Entity Type | Individual
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Provider Name | AMANDA ISABEL LOPEZ MS, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/16/2024
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 3001 GREEN BAY RD
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-3048
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Country | US
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Telephone | 224-610-4070
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Fax |
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Provider Business Mailing Address
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Address Line | 7240 HEATHER TRL
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City | JUSTICE
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State | IL
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Zip | 60458-1291
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Country | US
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Telephone | 708-574-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 056.015722
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License Number State | IL
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