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General NPI Number Information
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NPI Number | 1902361991
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Entity Type | Individual
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Provider Name | MRS. INDRA LUZ LOPEZ-ESTEVEZ
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Gender | Female
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 5373 THOMPSONS MILL RD
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City | HOSCHTON
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State | GA
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Zip | 30548-4037
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Country | US
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Telephone | 770-967-6555
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Fax |
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Provider Business Mailing Address
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Address Line | 3871 ZOEY LEE DR
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City | SNELLVILLE
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State | GA
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Zip | 30039-5257
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Country | US
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Telephone | 845-269-0787
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA001819
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License Number State | GA
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