Provider Demographics
NPI:1477283224
Name:BORSDORF, CORY AUGUST (COTA)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:AUGUST
Last Name:BORSDORF
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 SW FULTON RD
Mailing Address - Street 2:
Mailing Address - City:TOWANDA
Mailing Address - State:KS
Mailing Address - Zip Code:67144-9110
Mailing Address - Country:US
Mailing Address - Phone:316-755-6902
Mailing Address - Fax:
Practice Address - Street 1:929 N ST FRANCIS ST FL TOWER6
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-261-8303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00904224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant