Provider Demographics
NPI:1134427537
Name:LOPEZ, DAMARIS (MOT, CHT)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MOT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 W INA RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-6204
Mailing Address - Country:US
Mailing Address - Phone:520-462-0510
Mailing Address - Fax:520-762-4353
Practice Address - Street 1:265 W INA RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6204
Practice Address - Country:US
Practice Address - Phone:510-462-0510
Practice Address - Fax:520-762-4353
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ008538225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1134427537Medicaid