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NPI Code Detail

MEDICARE: DR. JESSICA LYNN LOPEZ SEELY OTD, OTR/L

MEDICARE: DR. JESSICA LYNN LOPEZ SEELY OTD, OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist027256NY
2225X00000XOccupational Therapist21512CA
3225X00000XOccupational Therapist027256NY
4225XN1300XNeurorehabilitation Occupational Therapist027256NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1027256OTHERNYNY OT LICENSE
2OT21512OTHERCACA OT LICENSE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104470830
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA LYNN LOPEZ SEELY OTD, OTR/L
Provider Business Mailing Address
First Line : 10 CAMELOT LN
Second Line :
City : EAST SETAUKET
State : NY
Zip : 11733-1707
Country : US
Telephone Number : 631-371-3178
Fax Number :
Provider Business Practice Location Address
First Line : 1239 N COUNTRY RD STE 4
Second Line :
City : STONY BROOK
State : NY
Zip : 11790-1920
Country : US
Telephone Number : 631-371-3178
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2019
Last Update Date : 01/07/2026

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