Provider Demographics
NPI:1578754800
Name:BOROS, KRISTEN WAYE
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:WAYE
Last Name:BOROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2666 SIERRA CYN
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-3736
Mailing Address - Country:US
Mailing Address - Phone:815-462-4928
Mailing Address - Fax:815-462-4929
Practice Address - Street 1:14409 EDISON DR UNIT I
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-3670
Practice Address - Country:US
Practice Address - Phone:815-462-4928
Practice Address - Fax:815-462-4929
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist