Individual
ETHAN BOREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MOT, OTR, L
Contact information
Practice address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
Mailing address
1005 BROADWAY ST, QUINCY, IL 62301-2834
(217) 223-8400
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056011119
IL
Other
Enumeration date
09/23/2016
Last updated
09/23/2016
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