Provider Demographics
NPI:1043977382
Name:MAST, JULIA (OTR/L)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:MAST
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1181
Mailing Address - Country:US
Mailing Address - Phone:610-724-9507
Mailing Address - Fax:
Practice Address - Street 1:406 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1181
Practice Address - Country:US
Practice Address - Phone:610-724-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06231225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist