Individual
JENNIFER LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
400 E MAIN ST, ALICE, TX 78332-4969
(361) 396-4029
Mailing address
400 E MAIN ST, ALICE, TX 78332-4969
(361) 396-4029
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
217554
TX
Other
Enumeration date
09/05/2022
Last updated
09/05/2022
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