Provider Demographics
NPI:1962630012
Name:CRUZ, YAMARIS MELINA (OTR/L)
Entity Type:Individual
Prefix:
First Name:YAMARIS
Middle Name:MELINA
Last Name:CRUZ
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 1:512 ONDERDONK AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1832
Mailing Address - Country:US
Mailing Address - Phone:917-544-2321
Mailing Address - Fax:
Practice Address - Street 1:512 ONDERDONK AVE APT 2R
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1832
Practice Address - Country:US
Practice Address - Phone:917-544-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012890-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics