Provider Demographics
NPI:1083868160
Name:CO-CRUZ, BERNICE KAYE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:KAYE
Last Name:CO-CRUZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:BERNICE
Other - Middle Name:KAYE
Other - Last Name:CO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:5000 BROADWAY
Mailing Address - Street 2:APT 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1602
Mailing Address - Country:US
Mailing Address - Phone:646-897-5879
Mailing Address - Fax:
Practice Address - Street 1:5000 BROADWAY
Practice Address - Street 2:APT 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1602
Practice Address - Country:US
Practice Address - Phone:646-897-5879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013511-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist