Provider Demographics
NPI:1003390865
Name:BULGER, GEORGE RICHARD (DROT, OTR/L)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RICHARD
Last Name:BULGER
Suffix:
Gender:M
Credentials:DROT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:PORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07758-1127
Mailing Address - Country:US
Mailing Address - Phone:347-513-9292
Mailing Address - Fax:
Practice Address - Street 1:46 MILLS AVE
Practice Address - Street 2:
Practice Address - City:PORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07758-1127
Practice Address - Country:US
Practice Address - Phone:347-513-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022930225X00000X
NJ46TR00928500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist