Provider Demographics
NPI:1457077968
Name:BONFIGLIO, FRANCES NICOLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:NICOLE
Last Name:BONFIGLIO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:MISS
Other - First Name:FRANCES
Other - Middle Name:NICOLE
Other - Last Name:PORTILLO-LLORENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:75 CRYSTAL RUN RD STE 201
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-7010
Mailing Address - Country:US
Mailing Address - Phone:845-692-4391
Mailing Address - Fax:
Practice Address - Street 1:75 CRYSTAL RUN RD STE 201
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-7010
Practice Address - Country:US
Practice Address - Phone:845-692-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09231300225X00000X
NY011179-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist