Provider Demographics
NPI:1033806252
Name:FONSECA, MARIA CELESTE (OTR)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CELESTE
Last Name:FONSECA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CELESTE
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1201 N. JACKSON RD. STE.900
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501
Mailing Address - Country:US
Mailing Address - Phone:956-661-0475
Mailing Address - Fax:956-621-7518
Practice Address - Street 1:1201 N. JACKSON RD. STE.900
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501
Practice Address - Country:US
Practice Address - Phone:956-661-0475
Practice Address - Fax:956-621-7518
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123526225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist