Provider Demographics
NPI:1104274455
Name:OSAZUWA, EVBAZIENGBERE (OTR)
Entity type:Individual
Prefix:MRS
First Name:EVBAZIENGBERE
Middle Name:
Last Name:OSAZUWA
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 1:14090 SOUTHWEST FWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3679
Mailing Address - Country:US
Mailing Address - Phone:832-361-8294
Mailing Address - Fax:713-456-2041
Practice Address - Street 1:4220 CARTWRIGHT RD STE 705
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5312
Practice Address - Country:US
Practice Address - Phone:832-490-8488
Practice Address - Fax:713-456-2041
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114807225XP0200X, 225X00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist