Provider Demographics
NPI:1144678335
Name:LOPEZ, REYNA LETICIA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:LETICIA
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4572
Mailing Address - Country:US
Mailing Address - Phone:209-598-7589
Mailing Address - Fax:
Practice Address - Street 1:1853 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4572
Practice Address - Country:US
Practice Address - Phone:209-598-7589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2025-08-15
Deactivation Date:2022-05-02
Deactivation Code:
Reactivation Date:2025-08-15
Provider Licenses
StateLicense IDTaxonomies
CA11110225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics