Provider Demographics
NPI:1831912385
Name:BLEICH, SUMMER STAR (OTR/L)
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:STAR
Last Name:BLEICH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SUMMER
Other - Middle Name:STAR
Other - Last Name:BLEICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:85 OCEAN GATE AVE
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-1421
Mailing Address - Country:US
Mailing Address - Phone:732-664-1424
Mailing Address - Fax:
Practice Address - Street 1:1769 HOOPER AVENUE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753
Practice Address - Country:US
Practice Address - Phone:732-913-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR01188300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist