Provider Demographics
NPI:1912265893
Name:GOTIANGCO, REYCIA R G (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:REYCIA
Middle Name:R G
Last Name:GOTIANGCO
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 1:62 PARK PL
Mailing Address - Street 2:RM. 303
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3208
Mailing Address - Country:US
Mailing Address - Phone:718-789-1191
Mailing Address - Fax:
Practice Address - Street 1:62 PARK PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-3208
Practice Address - Country:US
Practice Address - Phone:718-789-1191
Practice Address - Fax:718-857-2667
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016538-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist