Provider Demographics
NPI:1952115826
Name:CRUISE, CAITLYN MARIE (CAITLYN CRUISE OTR/L)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:MARIE
Last Name:CRUISE
Suffix:
Gender:F
Credentials:CAITLYN CRUISE OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11919 COUNTY ROAD E17
Mailing Address - Street 2:
Mailing Address - City:SCOTCH GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:52310-8311
Mailing Address - Country:US
Mailing Address - Phone:319-480-8093
Mailing Address - Fax:
Practice Address - Street 1:11919 COUNTY ROAD E17
Practice Address - Street 2:
Practice Address - City:SCOTCH GROVE
Practice Address - State:IA
Practice Address - Zip Code:52310-8311
Practice Address - Country:US
Practice Address - Phone:319-480-8093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125352225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist