Provider Demographics
NPI:1760435903
Name:RUIZ, GRISEL (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:GRISEL
Middle Name:
Last Name:RUIZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 GULF TO BAY BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-5346
Mailing Address - Country:US
Mailing Address - Phone:813-610-4143
Mailing Address - Fax:727-608-1991
Practice Address - Street 1:120 STATE ST E
Practice Address - Street 2:SUITE 105B
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3647
Practice Address - Country:US
Practice Address - Phone:813-610-4143
Practice Address - Fax:727-608-1991
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT4217225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890481200Medicaid
FL890481200Medicaid