Provider Demographics
NPI:1841576717
Name:BORCHARDT, KAILA MARIE (OT)
Entity type:Individual
Prefix:
First Name:KAILA
Middle Name:MARIE
Last Name:BORCHARDT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:KAILA
Other - Middle Name:MARIE
Other - Last Name:LUDOWESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:500 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:BIG STONE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57216-8237
Mailing Address - Country:US
Mailing Address - Phone:605-541-1140
Mailing Address - Fax:605-541-0109
Practice Address - Street 1:15620 EDGEWOOD DR STE 240
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56401-6984
Practice Address - Country:US
Practice Address - Phone:218-454-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105816225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist