Individual
MR. MARK ANTHONY BORES II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1168 SHETLAND DR, SOUTH LYON, MI 48178-5317
(248) 921-8965
Mailing address
1168 SHETLAND DR, SOUTH LYON, MI 48178-5317
(248) 921-8965
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201008661
MI
Other
Enumeration date
07/15/2018
Last updated
07/15/2018
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