Provider Demographics
NPI:1235138041
Name:BORCHERS, THEODORE PAUL (OTRL)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:PAUL
Last Name:BORCHERS
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 HIGHWAY 62 65 N STE A
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-1959
Mailing Address - Country:US
Mailing Address - Phone:870-743-4438
Mailing Address - Fax:870-741-0736
Practice Address - Street 1:1420 HIGHWAY 62 65 N STE A
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-1959
Practice Address - Country:US
Practice Address - Phone:870-743-4438
Practice Address - Fax:870-741-0736
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR423225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142590721Medicaid
AR142590721Medicaid