Provider Demographics
NPI:1659099331
Name:FONSECA, AMANDA (COTA/L)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:FONSECA
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 1:131 BROOME ST APT 23B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4042
Mailing Address - Country:US
Mailing Address - Phone:646-644-1505
Mailing Address - Fax:
Practice Address - Street 1:131 BROOME ST APT 23B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-4042
Practice Address - Country:US
Practice Address - Phone:646-644-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010942224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant