MEDICARE: EILEEN M LOPEZ M.A., O.T.R.

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1639391600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN M LOPEZ M.A., O.T.R.

Provider Business Mailing Address
First Line	:	211 E 60TH ST
Second Line	:	APT. D1
City	:	NEW YORK
State	:	NY
Zip	:	10022-1437
Country	:	US
Telephone Number	:	646-220-3149
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E 60TH ST
Second Line	:	APT. D1
City	:	NEW YORK
State	:	NY
Zip	:	10022-1437
Country	:	US
Telephone Number	:	646-220-3149
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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