Provider Demographics
NPI:1063760254
Name:BORER, JACQUELINE LEE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LEE
Last Name:BORER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-1945
Mailing Address - Country:US
Mailing Address - Phone:402-676-4869
Mailing Address - Fax:
Practice Address - Street 1:438 12TH ST
Practice Address - Street 2:
Practice Address - City:PAWNEE CITY
Practice Address - State:NE
Practice Address - Zip Code:68420-3589
Practice Address - Country:US
Practice Address - Phone:402-852-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001965225X00000X
NE1413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist