Provider Demographics
NPI:1215219845
Name:RUIZ, DOLORES JO (COTA)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:JO
Last Name:RUIZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 DUNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-6322
Mailing Address - Country:US
Mailing Address - Phone:914-457-8965
Mailing Address - Fax:
Practice Address - Street 1:39 DUNSTON AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6322
Practice Address - Country:US
Practice Address - Phone:914-457-8965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0068031224Z00000X
NJ46TA09070000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant