Provider Demographics
NPI:1417500893
Name:DIPASQUALE, AMY (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DIPASQUALE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 HIGHWAY 35 STE 311
Mailing Address - Street 2:
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1011
Mailing Address - Country:US
Mailing Address - Phone:732-800-3001
Mailing Address - Fax:732-800-3002
Practice Address - Street 1:2130 HIGHWAY 35 STE 311
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1011
Practice Address - Country:US
Practice Address - Phone:732-800-3001
Practice Address - Fax:732-800-3002
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00859300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist