MEDICARE: MR. SEAN MICHAEL CRUZ OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1477217594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEAN MICHAEL CRUZ OTR/L

Provider Business Mailing Address
First Line	:	15751 17TH RD APT 2
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-3253
Country	:	US
Telephone Number	:	347-651-7743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1960 BENEDICT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-4402
Country	:	US
Telephone Number	:	718-828-7301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	10/25/2021

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