Provider Demographics
NPI:1225150816
Name:MAGHRAK-FORD, MICHELE (OTR)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:MAGHRAK-FORD
Suffix:
Gender:
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WELFORD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77562-4540
Mailing Address - Country:US
Mailing Address - Phone:724-467-2567
Mailing Address - Fax:724-467-2567
Practice Address - Street 1:502 WELFORD LN
Practice Address - Street 2:
Practice Address - City:HIGHLANDS
Practice Address - State:TX
Practice Address - Zip Code:77562-4540
Practice Address - Country:US
Practice Address - Phone:724-467-2567
Practice Address - Fax:724-467-2567
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102755225X00000X
PAOC002685L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018898740006Medicaid