Provider Demographics
NPI:1447780408
Name:BOSSE-COLASME, KETSIA B (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:KETSIA
Middle Name:B
Last Name:BOSSE-COLASME
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E 93RD ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-1804
Mailing Address - Country:US
Mailing Address - Phone:347-328-7196
Mailing Address - Fax:
Practice Address - Street 1:325 E 93RD ST APT 2F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1804
Practice Address - Country:US
Practice Address - Phone:347-328-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist