Provider Demographics
NPI:1881898989
Name:RENKAS, MICHELLE ELISE (OTR)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:ELISE
Last Name:RENKAS
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:N8431 DUCKE DR
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-8400
Mailing Address - Country:US
Mailing Address - Phone:608-526-2819
Mailing Address - Fax:
Practice Address - Street 1:2600 WARD AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-7424
Practice Address - Country:US
Practice Address - Phone:608-787-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4271-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist