Provider Demographics
NPI:1154653103
Name:LOPEZ, LILIANA (OTR)
Entity Type:Individual
Prefix:MISS
First Name:LILIANA
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 W STATE AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-3684
Mailing Address - Country:US
Mailing Address - Phone:956-283-1806
Mailing Address - Fax:956-283-1803
Practice Address - Street 1:918 W STATE AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-3684
Practice Address - Country:US
Practice Address - Phone:956-283-1806
Practice Address - Fax:956-283-1803
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113463225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217335301Medicaid