Provider Demographics
NPI:1760153175
Name:OSBON, KACEY DANIELLE
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:DANIELLE
Last Name:OSBON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14737 HARRY FLOURNOY AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-1030
Mailing Address - Country:US
Mailing Address - Phone:318-267-2943
Mailing Address - Fax:
Practice Address - Street 1:2114 N ZARAGOZA RD STE C1
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8129
Practice Address - Country:US
Practice Address - Phone:152-718-0309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant