Provider Demographics
NPI:1174131544
Name:BORK, KIRSTEN ELIZABETH (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:ELIZABETH
Last Name:BORK
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 NW 23RD BLVD APT M85
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5920
Mailing Address - Country:US
Mailing Address - Phone:630-779-7693
Mailing Address - Fax:
Practice Address - Street 1:4113 NW 6TH ST STE BC
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-0731
Practice Address - Country:US
Practice Address - Phone:352-376-6300
Practice Address - Fax:352-372-0661
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20817225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist