Healthcare Provider Details

I. General information

NPI: 1598842866
Provider Name (Legal Business Name): FREEDOM INTERACTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 S JONES BLVD SUITE 121
LAS VEGAS NV
89146-3164
US

IV. Provider business mailing address

7065 W ANN RD #130-300
LAS VEGAS NV
89130-3865
US

V. Phone/Fax

Practice location:
  • Phone: 702-396-0101
  • Fax: 702-222-0212
Mailing address:
  • Phone: 702-396-0101
  • Fax: 702-222-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0470
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number0470
License Number StateNV

VIII. Authorized Official

Name: MRS. MONA HIBBERT AGAMEZ
Title or Position: OWNER
Credential: OTR/L
Phone: 702-393-0101