Individual
MADISON ROSE LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
199 COUNTY ROAD 111, FAIRFIELD, TX 75840-5405
(903) 390-8787
Mailing address
PO BOX 63, WORTHAM, TX 76693-0063
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216729
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5835
—
TX
Enumeration date
03/10/2021
Last updated
03/10/2021
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