MEDICARE: JESSICA 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	OT 14490	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881942878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LOPEZ

Provider Business Mailing Address
First Line	:	10475 SW 43RD ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4910
Country	:	US
Telephone Number	:	305-213-5725
Fax Number	:

Provider Business Practice Location Address
First Line	:	10475 SW 43RD ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4910
Country	:	US
Telephone Number	:	305-213-5725
Fax Number	:

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

Provider Enumeration Date	:	08/22/2012
Last Update Date	:	08/22/2012

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Directions to “ JESSICA LOPEZ ” Practice Location

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