Provider Demographics
NPI:1588955322
Name:BORSO, PUJA (OTR)
Entity type:Individual
Prefix:
First Name:PUJA
Middle Name:
Last Name:BORSO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 WEIDEMANN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-1249
Mailing Address - Country:US
Mailing Address - Phone:248-346-4515
Mailing Address - Fax:248-275-1133
Practice Address - Street 1:2995 WEIDEMANN DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1249
Practice Address - Country:US
Practice Address - Phone:248-346-4515
Practice Address - Fax:248-275-1133
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006770225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist