Provider Demographics
NPI:1447419908
Name:STAFFORD, IONE ELLOWENE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:IONE
Middle Name:ELLOWENE
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 COEUR D ALENE AVE
Mailing Address - Street 2:SUITE L2
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-704-8052
Mailing Address - Fax:
Practice Address - Street 1:421 E COEUR DALENE AVE
Practice Address - Street 2:SUITE L2
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-1704
Practice Address - Country:US
Practice Address - Phone:208-704-8052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID28741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist