Provider Demographics
NPI:1184909483
Name:BORER, BRYNN MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:BRYNN
Middle Name:MARIE
Last Name:BORER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6003
Mailing Address - Country:US
Mailing Address - Phone:575-439-4900
Mailing Address - Fax:575-439-4990
Practice Address - Street 1:900 1ST ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6003
Practice Address - Country:US
Practice Address - Phone:575-439-4900
Practice Address - Fax:575-439-4990
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3015225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics