Individual
MARIEL CLAUDIA LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1595 S CALUMET RD STE 3, CHESTERTON, IN 46304-2389
(219) 764-4888
Mailing address
PO BOX 2385, PORTAGE, IN 46368-5885
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200196020A
—
IN
Enumeration date
02/13/2018
Last updated
02/13/2018
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