Provider Demographics
NPI:1306590815
Name:IKEMEFUNA, OGUEJIOFOR S
Entity type:Individual
Prefix:
First Name:OGUEJIOFOR
Middle Name:S
Last Name:IKEMEFUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11314 ROSSIE MOOR LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1749
Mailing Address - Country:US
Mailing Address - Phone:832-474-0878
Mailing Address - Fax:
Practice Address - Street 1:16126 SOUTHWEST FWY STE 270
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2641
Practice Address - Country:US
Practice Address - Phone:832-474-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133468225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist