Provider Demographics
NPI:1952443384
Name:MAHONE, MICHELLE L (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:MAHONE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 ALLARD RD
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-0519
Mailing Address - Country:US
Mailing Address - Phone:972-921-6712
Mailing Address - Fax:
Practice Address - Street 1:106 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3794
Practice Address - Country:US
Practice Address - Phone:817-223-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106882225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172805702Medicaid
TX8T5485OtherBLUE CROSS BLUE SHIELD