Individual
JEANNIE LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
140 S BEACH ST STE 310, DAYTONA BEACH, FL 32114-4409
(386) 898-6040
(386) 256-2320
Mailing address
140 S BEACH ST STE 310, DAYTONA BEACH, FL 32114-4409
(386) 898-6040
(386) 256-2320
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA18189
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
450144
NBCOT
MD
Enumeration date
04/20/2021
Last updated
04/20/2021
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