MEDICARE: KAREN LOPEZ JIMENEZ

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
1	225XH1200X	Hand Occupational Therapist	OT-0006438	FL

General Provider Information

NPI Number	:	1154843787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LOPEZ JIMENEZ

Provider Business Mailing Address
First Line	:	320 BROADVIEW AVE
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-6233
Country	:	US
Telephone Number	:	305-978-4447
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WAYMONT CT STE 120
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3412
Country	:	US
Telephone Number	:	407-323-0399
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2017
Last Update Date	:	07/14/2017

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