Provider Demographics
NPI:1477826303
Name:LOPEZ, RAEJEAN LYNN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:RAEJEAN
Middle Name:LYNN
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:RAEJEAN
Other - Middle Name:L
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:455 NE 5TH AVE STE D330
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5658
Mailing Address - Country:US
Mailing Address - Phone:561-450-9576
Mailing Address - Fax:
Practice Address - Street 1:455 NE 5TH AVE STE D330
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5658
Practice Address - Country:US
Practice Address - Phone:561-450-9576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2017-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR5143225X00000X
OHOT007969225X00000X
NM3613225X00000X
FLOT18453225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist