Individual
GUILLERMO LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1121 E 7TH ST, AUSTIN, TX 78702-3220
(512) 334-4411
(512) 334-4465
Mailing address
1121 E 7TH ST, AUSTIN, TX 78702-3220
(512) 334-4411
(512) 334-4465
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104029
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8610GT
BCBS
TX
Enumeration date
03/06/2007
Last updated
07/08/2007
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