MEDICARE: JEANNINE CRUZ

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	1072802	OR
2	225X00000X	Occupational Therapist	46TR00376500	NJ

General Provider Information

NPI Number	:	1538537584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNINE CRUZ

Provider Business Mailing Address
First Line	:	3621 HIGHWAY 101 N
Second Line	:
City	:	GEARHART
State	:	OR
Zip	:	97138-4321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 HIGHWAY 101 N
Second Line	:
City	:	GEARHART
State	:	OR
Zip	:	97138-4321
Country	:	US
Telephone Number	:	201-410-9434
Fax Number	:

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

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	09/08/2015

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Directions to “ JEANNINE CRUZ ” Practice Location

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