Provider Demographics
NPI:1568622330
Name:BOSSE, ANGELA C (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:C
Last Name:BOSSE
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 1:17007 SE 35TH ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5819
Mailing Address - Country:US
Mailing Address - Phone:206-349-8045
Mailing Address - Fax:
Practice Address - Street 1:4430 TALBOT RD S
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6218
Practice Address - Country:US
Practice Address - Phone:425-226-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003966225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist