Provider Demographics
NPI:1962230227
Name:CARRAGINO, MICHAEL WAYNE (OTR/L)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WAYNE
Last Name:CARRAGINO
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 PRESQUE ISLE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15239-2673
Mailing Address - Country:US
Mailing Address - Phone:724-304-1910
Mailing Address - Fax:
Practice Address - Street 1:100 FREEDOM WAY
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9245
Practice Address - Country:US
Practice Address - Phone:724-853-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-08-08
Deactivation Date:2024-07-26
Deactivation Code:
Reactivation Date:2024-08-08
Provider Licenses
StateLicense IDTaxonomies
PA516523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist