Individual
MONICA LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
310 AUTUMN RIDGE DR, KOSCIUSKO, MS 39090-3242
(601) 289-7074
Mailing address
4109 HIGHWAY 98 W, SUMMIT, MS 39666-9132
(601) 276-3900
(601) 276-3938
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
3199
MS
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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