=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588955322
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PUJA BORSO OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2011
-----------------------------------------------------
Last Update Date | 05/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2995 WEIDEMANN DR
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48348-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-346-4515
-----------------------------------------------------
Fax | 248-275-1133
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2995 WEIDEMANN DR
-----------------------------------------------------
City | CLARKSTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48348-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-346-4515
-----------------------------------------------------
Fax | 248-275-1133
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 5201006770
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------