MEDICARE: MS. INGRID MICHELLE FONSECA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP1600X	Pastoral Counselor
2	104100000X	Social Worker
3	106H00000X	Marriage & Family Therapist
4	132700000X	Dietary Manager
5	173C00000X	Reflexologist
6	1744G0900X	Graphics Designer
7	222Q00000X	Developmental Therapist
8	225700000X	Massage Therapist
9	225C00000X	Rehabilitation Counselor
10	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1336315191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. INGRID MICHELLE FONSECA

Provider Business Mailing Address
First Line	:	255 WALTON BLVD
Second Line	:	SUITE #3
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2380
Country	:	US
Telephone Number	:	561-574-6521
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 WALTON BLVD
Second Line	:	SUITE #3
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2380
Country	:	US
Telephone Number	:	561-574-6521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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