Provider Demographics
NPI:1033202734
Name:LOPEZ, YAIDY E
Entity Type:Individual
Prefix:
First Name:YAIDY
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26977 VALESIDE LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-3126
Mailing Address - Country:US
Mailing Address - Phone:440-235-7780
Mailing Address - Fax:
Practice Address - Street 1:7250 OLD OAK BLVD.
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HTS.
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-243-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOTA-01561224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant