Provider Demographics
NPI:1790249175
Name:BORENITSCH, JAYNE (OTR/L, MS)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:BORENITSCH
Suffix:
Gender:F
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2827
Mailing Address - Country:US
Mailing Address - Phone:269-599-4681
Mailing Address - Fax:
Practice Address - Street 1:601 JOHN ST STE M-206C
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5359
Practice Address - Country:US
Practice Address - Phone:855-618-2676
Practice Address - Fax:269-488-8284
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201007453225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist