Provider Demographics
NPI:1518146125
Name:LOPEZ, MARISOL (COTA)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E NOLANA AVE
Mailing Address - Street 2:STE.10
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6104
Mailing Address - Country:US
Mailing Address - Phone:956-664-9904
Mailing Address - Fax:956-664-9879
Practice Address - Street 1:801 E NOLANA AVE
Practice Address - Street 2:STE.10
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6104
Practice Address - Country:US
Practice Address - Phone:956-664-9904
Practice Address - Fax:956-664-9879
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209399224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant