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General NPI Number Information
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NPI Number | 1629670674
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Entity Type | Individual
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Provider Name | OMAYRA LOPEZ LMT
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Gender | Female
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 747 FAWN RIDGE DR STE 100
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City | ORANGE CITY
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State | FL
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Zip | 32763-8268
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Country | US
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Telephone | 406-501-7591
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 ROSECLIFF CIR
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City | SANFORD
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State | FL
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Zip | 32773-7458
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Country | US
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Telephone |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA75341
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License Number State | FL
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