Provider Demographics
NPI:1366404758
Name:BURGER, BENJAMIN TYLER (OT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:TYLER
Last Name:BURGER
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 WHITE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-6816
Mailing Address - Country:US
Mailing Address - Phone:717-526-6936
Mailing Address - Fax:
Practice Address - Street 1:3399 TRINDLE RD
Practice Address - Street 2:FLOOR 2
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4413
Practice Address - Country:US
Practice Address - Phone:717-920-2620
Practice Address - Fax:717-920-2621
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008575225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist