Provider Demographics
NPI:1730632720
Name:LOPEZ, RAQUEL (COTA/L)
Entity type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6621 LAKE BLUE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3005
Mailing Address - Country:US
Mailing Address - Phone:786-768-3465
Mailing Address - Fax:866-546-3080
Practice Address - Street 1:17754 NW 59TH AVE
Practice Address - Street 2:102
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5149
Practice Address - Country:US
Practice Address - Phone:786-768-3465
Practice Address - Fax:866-546-3080
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA11986224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant