MEDICARE: ILIANA MICHELLE LOPEZ OTR

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	OT26711	FL

General Provider Information

NPI Number	:	1770233033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILIANA MICHELLE LOPEZ OTR

Provider Business Mailing Address
First Line	:	6941 NW 173RD DR APT 206
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-5587
Country	:	US
Telephone Number	:	786-527-0651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 W 50TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3440
Country	:	US
Telephone Number	:	305-231-3371
Fax Number	:

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

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	12/04/2025

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Directions to “ ILIANA MICHELLE LOPEZ OTR” Practice Location

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