Individual
MANUEL JOSE FONSECA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
122 E MONTGOMERY AVE STE D, SPOKANE, WA 99207-2219
(509) 838-2531
(509) 755-6580
Mailing address
PO BOX 3649, SPOKANE, WA 99220-3649
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT60336583
WA
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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