Provider Demographics
NPI:1902426943
Name:CAMACHO, RENITA SUN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:RENITA
Middle Name:SUN
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:RENITA
Other - Middle Name:DARIYA
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5440 HARVEST HILL RD STE 146
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6414
Mailing Address - Country:US
Mailing Address - Phone:972-587-7375
Mailing Address - Fax:
Practice Address - Street 1:5440 HARVEST HILL RD STE 146
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6414
Practice Address - Country:US
Practice Address - Phone:972-587-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124852225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist