Provider Demographics
NPI:1003170341
Name:LOPEZ, KELLYN (ATR-BC, LPAT)
Entity type:Individual
Prefix:MRS
First Name:KELLYN
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:ATR-BC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N UNION AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2173
Mailing Address - Country:US
Mailing Address - Phone:908-365-0358
Mailing Address - Fax:
Practice Address - Street 1:123 N UNION AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2173
Practice Address - Country:US
Practice Address - Phone:908-365-0358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00001500221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist