Provider Demographics
NPI:1245829845
Name:LOPEZ, GABRIELLA MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:MARIE
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 SW 169TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4870
Mailing Address - Country:US
Mailing Address - Phone:305-450-0631
Mailing Address - Fax:
Practice Address - Street 1:7820 SW 169TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-4870
Practice Address - Country:US
Practice Address - Phone:305-450-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21517225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist