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General NPI Number Information
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NPI Number | 1912859513
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Entity Type | Individual
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Provider Name | BETHANNIE NICOLE LOPEZ
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Gender | Female
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Dates
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Enumeration Date | 02/14/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 488 E 11TH AVE STE LL2
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City | EUGENE
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State | OR
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Zip | 97401-3601
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Country | US
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Telephone | 541-359-1009
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Fax |
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Provider Business Mailing Address
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Address Line | 1485 JOHN DAY DR UNIT 204
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City | COBURG
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State | OR
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Zip | 97408-6021
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Country | US
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Telephone | 541-359-1009
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 546669
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License Number State | OR
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