Provider Demographics
NPI:1659891653
Name:FORGASH, TRICIA MICHELLE (CTRS)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:MICHELLE
Last Name:FORGASH
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 DORCHESTER DR N APT 106
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-8321
Mailing Address - Country:US
Mailing Address - Phone:248-361-0716
Mailing Address - Fax:
Practice Address - Street 1:1998 DORCHESTER DR. N 106
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-361-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI52240225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist