Provider Demographics
NPI:1073135919
Name:BORAAS, BAILEY KESSLER (MOTR/L)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:KESSLER
Last Name:BORAAS
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2536
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-2536
Mailing Address - Country:US
Mailing Address - Phone:701-751-4115
Mailing Address - Fax:701-223-1669
Practice Address - Street 1:1138 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3556
Practice Address - Country:US
Practice Address - Phone:701-751-4115
Practice Address - Fax:701-223-1669
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1785225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1785OtherND BOARD OF OCCUPATIONAL THERAPY