Provider Demographics
NPI:1174505713
Name:BORKENHAGEN, CYNTHIA LYNN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:BORKENHAGEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:FILICELTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-521-9762
Practice Address - Fax:262-521-1091
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40830400Medicaid