Provider Demographics
NPI:1538204110
Name:AYLETT, ANDREW J (OTR, CHT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:AYLETT
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 HIGHWAY 34
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1821
Mailing Address - Country:US
Mailing Address - Phone:322-924-6807
Mailing Address - Fax:732-528-3851
Practice Address - Street 1:2414 HIGHWAY 34
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1821
Practice Address - Country:US
Practice Address - Phone:732-292-4680
Practice Address - Fax:732-528-3851
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00207900225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00207900OtherSTATE LICENSE
NJ6203780001Medicare NSC