Provider Demographics
NPI:1205540929
Name:FUENTES, ASHLEY N (OTD, OTR/L)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:N
Last Name:FUENTES
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 RANKIN ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206-1031
Mailing Address - Country:US
Mailing Address - Phone:908-374-9475
Mailing Address - Fax:
Practice Address - Street 1:201 RANKIN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206-1031
Practice Address - Country:US
Practice Address - Phone:908-374-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01098400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist