Provider Demographics
NPI:1376123950
Name:BORDEN, QUIANA (OTR)
Entity Type:Individual
Prefix:
First Name:QUIANA
Middle Name:
Last Name:BORDEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3478 LAKESIDE DR NE UNIT 1114
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1860
Mailing Address - Country:US
Mailing Address - Phone:216-313-0437
Mailing Address - Fax:
Practice Address - Street 1:12300 MORRIS RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4584
Practice Address - Country:US
Practice Address - Phone:678-740-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD445032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist