Active NPI
Immanuel T Cruz, OTR
- Occupational Therapist
- Stone Mountain, GA
National Provider Identifier
1780964387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT004739
- Practice address
- 2155 W Park CT
Suite G
Stone Mountain, GA 30087-3500 - Phone
- (770) 465-5084
- Fax
- (770) 465-5304
- NPI assigned
- Aug 26, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | OT004739 | GA | Primary |
Addresses
Primary practice location
2155 W Park CT
Suite G
Stone Mountain, GA 30087-3500
Mailing address
475 Paper Mill Dr
Lawrenceville, GA 30046-3193
Phone (404) 563-4593
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT004739 | GA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sierra Therapy Services, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Stone Mountain, GA
- NPI 1083643449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314316800000",
"number": "1780964387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "475 PAPER MILL DR",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300463193",
"telephone_number": "404-563-4593",
"fax_number": "770-465-5304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2155 W PARK CT",
"address_2": "SUITE G",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300873500",
"telephone_number": "770-465-5084",
"fax_number": "770-465-5304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "IMMANUEL",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "OTR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-08-26",
"last_updated": "2011-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "OT004739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stone Mountain, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.