Provider Demographics
NPI:1932696358
Name:FREIRE LEMOS, IVONE K
Entity Type:Individual
Prefix:MRS
First Name:IVONE
Middle Name:K
Last Name:FREIRE LEMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HAWKS RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-1795
Mailing Address - Country:US
Mailing Address - Phone:563-506-4431
Mailing Address - Fax:
Practice Address - Street 1:204 HAWKS RIDGE TRL
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-1795
Practice Address - Country:US
Practice Address - Phone:563-506-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118287225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist