Provider Demographics
NPI:1558084921
Name:BORRESON, HEIDI R (COTA)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:R
Last Name:BORRESON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 RIVERCREST DR N
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-2285
Mailing Address - Country:US
Mailing Address - Phone:608-864-1654
Mailing Address - Fax:
Practice Address - Street 1:4801 RIVERCREST DR N
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-2285
Practice Address - Country:US
Practice Address - Phone:608-864-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7017-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant