Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT6084 | FL |
NPI | 1033454228 |
---|---|
Provider Name | Ivelisse M Cruz-Lopez |
First Address | Ocala, FL 34472-9466 |
Second Address | Ocala, FL 34471-6005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2012 |
Last Update Date | 29/11/2012 |