Provider Demographics
NPI:1871789040
Name:GARDNER, JODI (OTRL)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:GARDNER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BRIDGEWATERS DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757
Mailing Address - Country:US
Mailing Address - Phone:732-542-6600
Mailing Address - Fax:732-542-6606
Practice Address - Street 1:14 BRIDGEWATERS DR STE A
Practice Address - Street 2:
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757-1184
Practice Address - Country:US
Practice Address - Phone:732-542-6600
Practice Address - Fax:732-542-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00347700225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics