Provider Demographics
NPI:1932775855
Name:BONGCAYAO, JANICE RACHEL (COTA/L)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:RACHEL
Last Name:BONGCAYAO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 WINTER GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2242
Mailing Address - Country:US
Mailing Address - Phone:530-781-3127
Mailing Address - Fax:
Practice Address - Street 1:1522 WINTER GREEN BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2242
Practice Address - Country:US
Practice Address - Phone:530-781-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18323224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant