Provider Demographics
NPI:1538646286
Name:BORDEN, KELLY (MOTR/L)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BORDEN
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5529 OLD US HIGHWAY 93
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MT
Mailing Address - Zip Code:59833-6564
Mailing Address - Country:US
Mailing Address - Phone:320-766-2402
Mailing Address - Fax:
Practice Address - Street 1:5529 OLD US HIGHWAY 93
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MT
Practice Address - Zip Code:59833-6564
Practice Address - Country:US
Practice Address - Phone:406-273-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-6086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist