Provider Demographics
NPI:1437357753
Name:BORCHERDING, GINA LOU (MSOTRL)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LOU
Last Name:BORCHERDING
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:IL
Mailing Address - Zip Code:62839-2601
Mailing Address - Country:US
Mailing Address - Phone:618-676-5169
Mailing Address - Fax:
Practice Address - Street 1:1042 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-2601
Practice Address - Country:US
Practice Address - Phone:618-676-5169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist