Provider Demographics
NPI:1104470830
Name:SEELY, JESSICA LYNN LOPEZ (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LYNN LOPEZ
Last Name:SEELY
Suffix:
Gender:
Credentials:OTD, OTR/L
Other - Prefix:DR
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10 CAMELOT LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CAMELOT LN
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1707
Practice Address - Country:US
Practice Address - Phone:631-371-3178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21512225X00000X
NY027256225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY027256OtherNY OT LICENSE
FLOT18987OtherFLORIDA OT BOARD
CAOT21512OtherCA OT LICENSE