Healthcare Provider Details

I. General information

NPI: 1144623554
Provider Name (Legal Business Name): LAUREN MIKEL FONSECA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15530 E BRONCOS PKWY UNIT 100
CENTENNIAL CO
80112-7111
US

IV. Provider business mailing address

7000 MERCURY TRL
AMARILLO TX
79118-1502
US

V. Phone/Fax

Practice location:
  • Phone: 720-432-2860
  • Fax: 720-789-2210
Mailing address:
  • Phone: 832-794-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number10823
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0004126
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: