Healthcare Provider Details

I. General information

NPI: 1063472355
Provider Name (Legal Business Name): DARA BORISOFF MCKENZIE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 IRONWOOD DR
SANDY HOOK CT
06482-1227
US

IV. Provider business mailing address

7 IRONWOOD DR
SANDY HOOK CT
06482-1227
US

V. Phone/Fax

Practice location:
  • Phone: 914-260-4589
  • Fax:
Mailing address:
  • Phone: 914-260-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003673
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number013892-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: