Provider Demographics
NPI:1649339334
Name:BORST, MICHAEL J
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BORST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6408 COPPS AVE
Mailing Address - Street 2:MERITER HAND THERAPY
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3702
Mailing Address - Country:US
Mailing Address - Phone:608-417-3131
Mailing Address - Fax:608-417-3130
Practice Address - Street 1:6408 COPPS AVE
Practice Address - Street 2:MERITER HAND THERAPY
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3702
Practice Address - Country:US
Practice Address - Phone:608-417-3131
Practice Address - Fax:608-417-3130
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1941-026225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41035200Medicaid