Provider Demographics
NPI:1588986160
Name:MCMASTERS, DENNIS ALAN (OTR)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ALAN
Last Name:MCMASTERS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8908
Mailing Address - Country:US
Mailing Address - Phone:317-292-5948
Mailing Address - Fax:
Practice Address - Street 1:4021 STONERIDGE DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8908
Practice Address - Country:US
Practice Address - Phone:317-292-5948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-23
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31002630A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000720860OtherANTHEM PROVIDER NUMBER
IN201025210Medicaid
IN000000720860OtherANTHEM PROVIDER NUMBER
INP01078475Medicare PIN