Provider Demographics
NPI:1750037529
Name:GIRARD, ASHLEY SAGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SAGE
Last Name:GIRARD
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 1:10 BELL CT
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-1601
Mailing Address - Country:US
Mailing Address - Phone:864-546-1588
Mailing Address - Fax:
Practice Address - Street 1:1405 ROUTE 18
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3719
Practice Address - Country:US
Practice Address - Phone:732-576-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01047400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR01047400OtherNJ CONSUMER AFFAIRS