MEDICARE: ALEXANDRA LOPEZ

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	OT15510	FL

General Provider Information

NPI Number	:	1871833343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA LOPEZ

Provider Business Mailing Address
First Line	:	3213 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-2605
Country	:	US
Telephone Number	:	305-442-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-2605
Country	:	US
Telephone Number	:	305-442-0557
Fax Number	:

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

Provider Enumeration Date	:	02/21/2013
Last Update Date	:	02/21/2013

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