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Organization
ITHERAPY OT, PC.
Active
Organization
ITHERAPY OT, PC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. IVY GRACE MANDAP LOPEZ OTR/L (PRESIDENT)
(914) 426-9779
Entity
Organization
Contact information
Practice address
339 MORRIS AVE, BRONX, NY 10451-6122
(914) 426-9779
(718) 880-1240
Mailing address
8829 180TH ST FL 2, JAMAICA, NY 11432-4737
(914) 426-9779
(718) 880-1240
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18985
NYSED
NY
Enumeration date
05/10/2019
Last updated
05/10/2019
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