Provider Demographics
NPI:1750621132
Name:MASON, DREW FOSTER (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:DREW
Middle Name:FOSTER
Last Name:MASON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:MR
Other - First Name:DREW
Other - Middle Name:FOSTER
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ATC
Mailing Address - Street 1:BOX 1746 54 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201
Mailing Address - Country:US
Mailing Address - Phone:304-473-8349
Mailing Address - Fax:304-473-8349
Practice Address - Street 1:54 COLLEGE AVENUE
Practice Address - Street 2:BOX 1746
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201
Practice Address - Country:US
Practice Address - Phone:304-473-8349
Practice Address - Fax:304-473-8349
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAT0011502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer