Provider Demographics
NPI:1366625121
Name:BOROS, CARMEN R (OTR/L)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:R
Last Name:BOROS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-3448
Mailing Address - Country:US
Mailing Address - Phone:919-739-0047
Mailing Address - Fax:919-739-9041
Practice Address - Street 1:1214 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-3448
Practice Address - Country:US
Practice Address - Phone:919-739-0047
Practice Address - Fax:919-739-9041
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7278225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065477702Medicaid