Provider Demographics
NPI:1205102779
Name:LOPERA-SARRIA, ISABEL CRISTINA (OTR/L)
Entity type:Individual
Prefix:MS
First Name:ISABEL
Middle Name:CRISTINA
Last Name:LOPERA-SARRIA
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 1:6633 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1631
Mailing Address - Country:US
Mailing Address - Phone:347-531-9527
Mailing Address - Fax:
Practice Address - Street 1:6754 80TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-2926
Practice Address - Country:US
Practice Address - Phone:718-326-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012057-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0555130Medicaid