Provider Demographics
NPI:1154326510
Name:RENDE, MICHAEL A (OT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:RENDE
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HESTERS CROSSING RD
Mailing Address - Street 2:STE 160
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-6914
Mailing Address - Country:US
Mailing Address - Phone:512-310-1928
Mailing Address - Fax:512-310-9180
Practice Address - Street 1:301 HESTERS CROSSING RD
Practice Address - Street 2:STE 160
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6914
Practice Address - Country:US
Practice Address - Phone:512-310-1928
Practice Address - Fax:512-310-9180
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110815225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609830Medicare ID - Type Unspecified