Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2299 | OK |
NPI | 1013309236 |
---|---|
Provider Name | Mr. Temitope Olaniwun |
First Address | Oklahoma City, OK 73116-1667 |
Second Address | Oklahoma City, OK 73112-5474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2015 |
Last Update Date | 25/02/2015 |