Provider Demographics
NPI:1295217164
Name:BORRIES, ROSE CATHERINE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:CATHERINE
Last Name:BORRIES
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:CATHERINE
Other - Last Name:NIEMERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:15575 E STATE HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-3854
Mailing Address - Country:US
Mailing Address - Phone:217-994-1316
Mailing Address - Fax:
Practice Address - Street 1:1301 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1779
Practice Address - Country:US
Practice Address - Phone:217-347-1243
Practice Address - Fax:217-347-1558
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
056.011949225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist