Individual
GINA JASMIN LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5069 WALNUT RIDGE DR, ORLANDO, FL 32829-8271
(321) 303-6276
(321) 235-7311
Mailing address
5069 WALNUT RIDGE DR, ORLANDO, FL 32829-8271
(321) 303-6276
(321) 235-7311
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA15567
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA15567
STATE LICENSE
FL
Enumeration date
05/22/2019
Last updated
05/22/2019
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