MEDICARE: OLIVER CHAD ONG 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	225X00000X	Occupational Therapist	16-0711	NV

General Provider Information

NPI Number	:	1437637170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVER CHAD ONG CRUZ OTR/L

Provider Business Mailing Address
First Line	:	5576 JINSHA RIVER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7712
Country	:	US
Telephone Number	:	702-523-2758
Fax Number	:

Provider Business Practice Location Address
First Line	:	5576 JINSHA RIVER ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7712
Country	:	US
Telephone Number	:	702-523-2758
Fax Number	:

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

Provider Enumeration Date	:	08/03/2018
Last Update Date	:	02/01/2020

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