Provider Demographics
NPI:1508565748
Name:BUSTOS, SELESTE SELENA (OTR, OTD)
Entity Type:Individual
Prefix:
First Name:SELESTE
Middle Name:SELENA
Last Name:BUSTOS
Suffix:
Gender:F
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 BOREAS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-4820
Mailing Address - Country:US
Mailing Address - Phone:281-978-1296
Mailing Address - Fax:
Practice Address - Street 1:12515 BOREAS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-4820
Practice Address - Country:US
Practice Address - Phone:281-978-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123411225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist