Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | NY |
NPI | 1003455791 |
---|---|
Provider Name | Melissa Cruz |
First Address | Copiague, NY 11726-2600 |
Second Address | Fresh Meadows, NY 11365-1454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2019 |
Last Update Date | 30/12/2019 |