Provider Demographics
NPI:1255578795
Name:DE LA ROSA, JANIE FONSECA (OTR)
Entity type:Individual
Prefix:MRS
First Name:JANIE
Middle Name:FONSECA
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-0000
Mailing Address - Country:US
Mailing Address - Phone:956-929-1684
Mailing Address - Fax:
Practice Address - Street 1:1315 W. MAIN A, SUITE 11
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-0000
Practice Address - Country:US
Practice Address - Phone:956-580-1100
Practice Address - Fax:956-580-1138
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112032225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist