MEDICARE: MS. CHERYLL DANE CRUZ 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	014766-1	NY

General Provider Information

NPI Number	:	1689986812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYLL DANE CRUZ CRUZ OTR/L

Provider Business Mailing Address
First Line	:	3310 QUEENS BLVD
Second Line	:	SUITE 301
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2302
Country	:	US
Telephone Number	:	718-593-4121
Fax Number	:	718-268-2646

Provider Business Practice Location Address
First Line	:	3310 QUEENS BLVD
Second Line	:	SUITE 301
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2302
Country	:	US
Telephone Number	:	718-593-4121
Fax Number	:	718-268-2646

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

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	07/02/2010

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