Provider Demographics
NPI:1336337856
Name:LOPEZ, AMBAR (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:AMBAR
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:AMBAR
Other - Middle Name:
Other - Last Name:CUELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8137 CANTERBURY LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6681
Mailing Address - Country:US
Mailing Address - Phone:813-770-0073
Mailing Address - Fax:
Practice Address - Street 1:1513 SUN CITY CENTER PLZ STE C
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5390
Practice Address - Country:US
Practice Address - Phone:813-634-6022
Practice Address - Fax:813-634-6053
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11706225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist