Provider Demographics
NPI:1588161970
Name:CRUZ IRIZARRY, RUTH DANITZA (OT)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:DANITZA
Last Name:CRUZ IRIZARRY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N MAITLAND AVE # 948476
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5515
Mailing Address - Country:US
Mailing Address - Phone:407-694-9328
Mailing Address - Fax:
Practice Address - Street 1:151 N MAITLAND AVE # 948476
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5515
Practice Address - Country:US
Practice Address - Phone:407-694-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13471225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist