Provider Demographics
NPI:1144873860
Name:BORDEN, MELINDA ZEHNER (OTR/L)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:ZEHNER
Last Name:BORDEN
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 1:1602 SANDCHERRY CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3329
Mailing Address - Country:US
Mailing Address - Phone:217-417-5140
Mailing Address - Fax:
Practice Address - Street 1:2501 FIELDS SOUTH DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3733
Practice Address - Country:US
Practice Address - Phone:217-359-9622
Practice Address - Fax:217-356-7964
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056006413225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist