Provider Demographics
NPI:1750567681
Name:ARGONCILLO, FREDERICK (OTR/L, CLT)
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:ARGONCILLO
Suffix:
Gender:M
Credentials:OTR/L, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4458 LISETTE CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34604-5812
Mailing Address - Country:US
Mailing Address - Phone:352-442-4244
Mailing Address - Fax:
Practice Address - Street 1:4458 LISETTE CIR
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34604-5812
Practice Address - Country:US
Practice Address - Phone:352-442-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist