Provider Demographics
NPI:1750481230
Name:CRUZ, LIZABELLE ORTIZ (OTL/R)
Entity type:Individual
Prefix:MISS
First Name:LIZABELLE
Middle Name:ORTIZ
Last Name:CRUZ
Suffix:
Gender:F
Credentials:OTL/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-0236
Mailing Address - Country:US
Mailing Address - Phone:727-542-3580
Mailing Address - Fax:
Practice Address - Street 1:10707 66TH ST N STE 14
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2336
Practice Address - Country:US
Practice Address - Phone:727-547-8600
Practice Address - Fax:727-548-6131
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT6356225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU6473YOtherMEDICARE PROVIDER NUMBER