Provider Demographics
NPI:1285917799
Name:AHERN, RYAN THOMAS (MS OT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:THOMAS
Last Name:AHERN
Suffix:
Gender:M
Credentials:MS OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2802
Mailing Address - Country:US
Mailing Address - Phone:908-403-9436
Mailing Address - Fax:
Practice Address - Street 1:334 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2802
Practice Address - Country:US
Practice Address - Phone:908-403-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00491600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist