MEDICARE: JAMIE MASTEN OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OC009541	PA

General Provider Information

NPI Number	:	1659335834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE MASTEN OTR

Provider Business Mailing Address
First Line	:	1600 CORAOPOLIS HEIGHTS RD
Second Line	:
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-4316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 CORAOPOLIS HEIGHTS RD
Second Line	:
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-4316
Country	:	US
Telephone Number	:	412-269-7062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/26/2021

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