Provider Demographics
NPI:1467597732
Name:CAVENDER, MICHAEL HOWARD (OT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HOWARD
Last Name:CAVENDER
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 1:208 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-9303
Mailing Address - Country:US
Mailing Address - Phone:831-338-1592
Mailing Address - Fax:
Practice Address - Street 1:1715 LUNDY AVE
Practice Address - Street 2:SUITE 132
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1837
Practice Address - Country:US
Practice Address - Phone:408-436-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6234225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand