Provider Demographics
NPI:1629938154
Name:LOPEZ, YUDI NATHALY (OTRL)
Entity type:Individual
Prefix:
First Name:YUDI
Middle Name:NATHALY
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:865-927-6021
Mailing Address - Fax:
Practice Address - Street 1:301 S GALLAHER VIEW RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5355
Practice Address - Country:US
Practice Address - Phone:865-927-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8510225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist