Provider Demographics
NPI:1578881223
Name:RENDON, SELMA LIVIA
Entity Type:Individual
Prefix:
First Name:SELMA
Middle Name:LIVIA
Last Name:RENDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8719 COPPERBROOK DR STE G
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4575
Mailing Address - Country:US
Mailing Address - Phone:956-655-6972
Mailing Address - Fax:
Practice Address - Street 1:9230 KIRBY DR STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2541
Practice Address - Country:US
Practice Address - Phone:713-497-5335
Practice Address - Fax:833-891-3211
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113641225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113641OtherOCCUPATIONAL THERAPIST