Provider Demographics
NPI:1255628293
Name:BOUSKA, DEONNA LEA (CMT)
Entity type:Individual
Prefix:MS
First Name:DEONNA
Middle Name:LEA
Last Name:BOUSKA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18542 DRIFTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55320-1617
Mailing Address - Country:US
Mailing Address - Phone:320-420-1463
Mailing Address - Fax:
Practice Address - Street 1:18542 DRIFTWOOD RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:MN
Practice Address - Zip Code:55320-1617
Practice Address - Country:US
Practice Address - Phone:320-420-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist