Provider Demographics
NPI:1255052890
Name:FRANCISCO, FRANC IVAN (COTA/L)
Entity type:Individual
Prefix:MR
First Name:FRANC IVAN
Middle Name:
Last Name:FRANCISCO
Suffix:
Gender:M
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 1:90 FERRIS AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-3428
Mailing Address - Country:US
Mailing Address - Phone:914-469-0975
Mailing Address - Fax:
Practice Address - Street 1:707 THROGGS NECK EXPY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2319
Practice Address - Country:US
Practice Address - Phone:914-469-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010774224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant