Active NPI
Mark Luke Dizon Cruz, OTL
- Occupational Therapist
- McKinney, TX
National Provider Identifier
1760057657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 111909
- Practice address
- 4510 Medical Center Dr
McKinney, TX 75069-1650 - Phone
- (972) 540-8081
- NPI assigned
- May 24, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 111909 | TX | Primary |
Addresses
Primary practice location
4510 Medical Center Dr
McKinney, TX 75069-1650
Mailing address
1705 Elm Spring CT
Allen, TX 75002-6393
Phone (972) 832-1352
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 111909 | TX | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1621814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621814400000",
"number": "1760057657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 ELM SPRING CT",
"city": "ALLEN",
"state": "TX",
"postal_code": "750026393",
"telephone_number": "972-832-1352"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4510 MEDICAL CENTER DR",
"city": "MCKINNEY",
"state": "TX",
"postal_code": "750691650",
"telephone_number": "972-540-8081"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "MARK LUKE",
"middle_name": "DIZON",
"name_prefix": "Mr.",
"credential": "OTL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-24",
"last_updated": "2021-05-24",
"certification_date": "2021-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "111909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McKinney, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.