Provider Demographics
NPI:1972169092
Name:LOPEZ, KAREN CARRILLO (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:CARRILLO
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 NW 9TH PL
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6119
Mailing Address - Country:US
Mailing Address - Phone:954-624-2073
Mailing Address - Fax:
Practice Address - Street 1:9224 NW 9TH PL
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-6119
Practice Address - Country:US
Practice Address - Phone:954-624-2073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist