Provider Demographics
NPI:1861631194
Name:BOSCO, DEANNA G (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:G
Last Name:BOSCO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4423 SHADOWDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-8718
Mailing Address - Country:US
Mailing Address - Phone:281-392-4221
Mailing Address - Fax:281-392-4225
Practice Address - Street 1:4423 SHADOWDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-8718
Practice Address - Country:US
Practice Address - Phone:281-392-4221
Practice Address - Fax:281-392-4225
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116503225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics