Provider Demographics
NPI:1396460325
Name:BOREK, CATHERINE JEAN (OT)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JEAN
Last Name:BOREK
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:JEAN
Other - Last Name:COLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:1000 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1116
Mailing Address - Country:US
Mailing Address - Phone:192-025-7579
Mailing Address - Fax:920-257-2004
Practice Address - Street 1:4000 N PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8018
Practice Address - Country:US
Practice Address - Phone:920-968-0814
Practice Address - Fax:920-734-6159
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1784-26225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1784-26OtherLICENSE NUMBER