Provider Demographics
NPI:1477910784
Name:ESTEVES, LISMARIEL (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:LISMARIEL
Middle Name:
Last Name:ESTEVES
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 PIEDMONT LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5938
Mailing Address - Country:US
Mailing Address - Phone:321-402-2203
Mailing Address - Fax:
Practice Address - Street 1:2011 PIEDMONT LN
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5938
Practice Address - Country:US
Practice Address - Phone:321-402-2203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist