Provider Demographics
NPI:1154422699
Name:RENAUD, TAMARA LYNN (OTR)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:RENAUD
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 1:701 CLEARWATER TRL
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2734
Mailing Address - Country:US
Mailing Address - Phone:972-463-0117
Mailing Address - Fax:469-361-6496
Practice Address - Street 1:3140 ANNA CADE CIR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7424
Practice Address - Country:US
Practice Address - Phone:972-463-0117
Practice Address - Fax:469-361-6496
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110673225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist