Healthcare Provider Details

I. General information

NPI: 1639359128
Provider Name (Legal Business Name): BENJAMIN A MAST MS, OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 EASTON-NAZARETH HWY. SUITE 202
EASTON PA
18045
US

IV. Provider business mailing address

3929 EASTON-NAZARETH HWY. SUITE 202
EASTON PA
18045
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-7094
  • Fax: 610-258-6107
Mailing address:
  • Phone: 610-258-7094
  • Fax: 610-258-6107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC010581
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: