Provider Demographics
NPI:1811231053
Name:LOPEZ, KATHY SULEIDY (LMT)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:SULEIDY
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15900 SW 35TH COURT RD
Mailing Address - Street 2:APT 1
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-3357
Mailing Address - Country:US
Mailing Address - Phone:352-693-8755
Mailing Address - Fax:
Practice Address - Street 1:1302 SE 25TH LOOP
Practice Address - Street 2:SUITE 104
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1027
Practice Address - Country:US
Practice Address - Phone:352-693-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 68516174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist