Provider Demographics
NPI:1336684950
Name:FORD, MAISHA
Entity Type:Individual
Prefix:
First Name:MAISHA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NE 70TH ST
Mailing Address - Street 2:OKLAHOMA CITY
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-6009
Mailing Address - Country:US
Mailing Address - Phone:405-831-7649
Mailing Address - Fax:
Practice Address - Street 1:825 NE 70TH ST
Practice Address - Street 2:OKLAHOMA CITY
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-6009
Practice Address - Country:US
Practice Address - Phone:405-831-7649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management