Provider Demographics
NPI:1982818969
Name:MCGONIGLE, BECKY R
Entity Type:Individual
Prefix:MS
First Name:BECKY
Middle Name:R
Last Name:MCGONIGLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20532 MACON PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-3967
Mailing Address - Country:US
Mailing Address - Phone:407-568-4969
Mailing Address - Fax:
Practice Address - Street 1:1836 BLAINE TER
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1768
Practice Address - Country:US
Practice Address - Phone:407-539-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist