Individual
ELLISE MARIEL LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
151 E MINNEHAHA AVE, CLERMONT, FL 34711-3424
(352) 394-2188
Mailing address
7146 CONWAY RD APT 1211, ORLANDO, FL 32812-3837
(321) 205-6178
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT25441
FL
Other
Enumeration date
09/16/2025
Last updated
09/16/2025
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