Provider Demographics
NPI:1679169494
Name:BOSWORTH, DONNA LEE
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LEE
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:L EE
Other - Last Name:LAYPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 ELM ST
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-3422
Mailing Address - Country:US
Mailing Address - Phone:508-993-1434
Mailing Address - Fax:
Practice Address - Street 1:275 ELM ST
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-3422
Practice Address - Country:US
Practice Address - Phone:508-993-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer