Provider Demographics
NPI:1912077793
Name:BOREL, ROBIN DENISE (OT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:DENISE
Last Name:BOREL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S MEDFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75901-5633
Mailing Address - Country:US
Mailing Address - Phone:936-639-1141
Mailing Address - Fax:936-635-5685
Practice Address - Street 1:4101 S MEDFORD DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5633
Practice Address - Country:US
Practice Address - Phone:936-639-1141
Practice Address - Fax:636-635-5685
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105092225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126792OtherSUPERIOR-CHIP
TX004491901Medicaid
TX82601TOtherBLUE CROSS BLUE SHIELD