Provider Demographics
NPI:1639359128
Name:MAST, BENJAMIN A (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:A
Last Name:MAST
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 EASTON-NAZARETH HWY.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045
Mailing Address - Country:US
Mailing Address - Phone:610-258-7094
Mailing Address - Fax:610-258-6107
Practice Address - Street 1:3929 EASTON-NAZARETH HWY.
Practice Address - Street 2:SUITE 202
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045
Practice Address - Country:US
Practice Address - Phone:610-258-7094
Practice Address - Fax:610-258-6107
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC010581225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00477651OtherRAILROAD MEDICARE
PA121570KXHMedicare PIN