Provider Demographics
NPI:1235252909
Name:BORR, EVORA ANN
Entity Type:Individual
Prefix:MRS
First Name:EVORA
Middle Name:ANN
Last Name:BORR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 134TH AVE
Mailing Address - Street 2:B
Mailing Address - City:HAMILTON
Mailing Address - State:MI
Mailing Address - Zip Code:49419-8552
Mailing Address - Country:US
Mailing Address - Phone:616-994-6801
Mailing Address - Fax:
Practice Address - Street 1:4601 134TH
Practice Address - Street 2:B
Practice Address - City:HAMILTON
Practice Address - State:MI
Practice Address - Zip Code:49419-2180
Practice Address - Country:US
Practice Address - Phone:616-994-6801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICERTIFICATE225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist