Individual
MR. IMMANUEL T CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
2155 W PARK CT, SUITE G, STONE MOUNTAIN, GA 30087-3500
(770) 465-5084
(770) 465-5304
Mailing address
475 PAPER MILL DR, LAWRENCEVILLE, GA 30046-3193
(404) 563-4593
(770) 465-5304
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004739
GA
Other
Enumeration date
08/26/2011
Last updated
08/26/2011
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