Provider Demographics
NPI:1508058025
Name:PURDY, MICHELLE (OTR/CHT, MBA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:PURDY
Suffix:
Gender:F
Credentials:OTR/CHT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 OAK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 S IH 35 STE L1
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-6915
Practice Address - Country:US
Practice Address - Phone:512-238-6200
Practice Address - Fax:512-238-6700
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106584OtherLICENSE#