Provider Demographics
NPI:1144234717
Name:LOPEZ, JOE ANDREW (OT)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:ANDREW
Last Name:LOPEZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 LAZY LN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-9464
Mailing Address - Country:US
Mailing Address - Phone:512-392-1833
Mailing Address - Fax:512-392-1838
Practice Address - Street 1:1401 WONDER WORLD DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7555
Practice Address - Country:US
Practice Address - Phone:512-396-8271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist