Provider Demographics
NPI:1902470628
Name:LOPEZ, KATELYN COLLEEN (MT-BC)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:COLLEEN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:KATEY
Other - Middle Name:COLLEEN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MT-BC
Mailing Address - Street 1:6603 AUGUSTA PINES PKWY E
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4054
Mailing Address - Country:US
Mailing Address - Phone:801-201-9263
Mailing Address - Fax:
Practice Address - Street 1:6603 AUGUSTA PINES PKWY E
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-4054
Practice Address - Country:US
Practice Address - Phone:801-201-9263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist