Provider Demographics
NPI:1457581092
Name:BORREGO, MARK (OTR)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BORREGO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-4700
Mailing Address - Country:US
Mailing Address - Phone:303-770-4682
Mailing Address - Fax:303-770-4812
Practice Address - Street 1:7100 W 13TH AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-4700
Practice Address - Country:US
Practice Address - Phone:303-770-4682
Practice Address - Fax:303-770-4812
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1021498225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist