Provider Demographics
NPI:1790846715
Name:CRUZ, WINDY O (OTR/L, OTD, SCLV)
Entity Type:Individual
Prefix:
First Name:WINDY
Middle Name:O
Last Name:CRUZ
Suffix:
Gender:F
Credentials:OTR/L, OTD, SCLV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4962 FALCON WOOD CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1283
Mailing Address - Country:US
Mailing Address - Phone:404-617-0428
Mailing Address - Fax:678-505-1436
Practice Address - Street 1:4962 FALCON WOOD CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-1283
Practice Address - Country:US
Practice Address - Phone:404-617-0428
Practice Address - Fax:678-505-1436
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3955225XP0200X
GAOT003955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA894267979AMedicaid
GA3955OtherOCCUPATIONAL LICENSE
GA894267979AMedicaid