Provider Demographics
NPI:1043031941
Name:FONSECA-KEMP, MADISON TAYLOR (OTR)
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:TAYLOR
Last Name:FONSECA-KEMP
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 1:170 SMOKE RISE CIR
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-1038
Mailing Address - Country:US
Mailing Address - Phone:401-714-8522
Mailing Address - Fax:
Practice Address - Street 1:1565 N MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2972
Practice Address - Country:US
Practice Address - Phone:508-324-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics