Provider Demographics
NPI:1588193957
Name:BUMACTAO, MICHELLE CAPALARAN (OTR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CAPALARAN
Last Name:BUMACTAO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 BLUFFSTONE CV STE A201
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7846
Mailing Address - Country:US
Mailing Address - Phone:800-967-2414
Mailing Address - Fax:
Practice Address - Street 1:8500 BLUFFSTONE CV STE A201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7846
Practice Address - Country:US
Practice Address - Phone:800-967-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX119592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program