Provider Demographics
NPI:1104079953
Name:COLON, EMMA R. CRUZ (OTR)
Entity type:Individual
Prefix:MRS
First Name:EMMA R.
Middle Name:CRUZ
Last Name:COLON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAN FRANCISCO STREET URB. LOS DOMINICOS
Mailing Address - Street 2:P-298
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-502-8343
Mailing Address - Fax:
Practice Address - Street 1:SAN FRANCISCO STREET URB. LOS DOMINICOS
Practice Address - Street 2:P-298
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-502-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR298225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist