Provider Demographics
NPI:1275202400
Name:HAGER, RYLEA
Entity Type:Individual
Prefix:
First Name:RYLEA
Middle Name:
Last Name:HAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BEACH HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08008-1567
Mailing Address - Country:US
Mailing Address - Phone:609-661-5971
Mailing Address - Fax:
Practice Address - Street 1:1107 WEST AVE
Practice Address - Street 2:
Practice Address - City:BEACH HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:08008-1567
Practice Address - Country:US
Practice Address - Phone:609-661-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC017603225X00000X
NJ46TR01045400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist