MEDICARE: JANICE RACHEL BONGCAYAO COTA/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	18323	FL

General Provider Information

NPI Number	:	1932775855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE RACHEL BONGCAYAO COTA/L

Provider Business Mailing Address
First Line	:	1522 WINTER GREEN BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2242
Country	:	US
Telephone Number	:	530-781-3127
Fax Number	:

Provider Business Practice Location Address
First Line	:	1522 WINTER GREEN BLVD
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-2242
Country	:	US
Telephone Number	:	530-781-3127
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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