Provider Demographics
NPI:1174071112
Name:OMOLABI, OLAKUNLE
Entity type:Individual
Prefix:
First Name:OLAKUNLE
Middle Name:
Last Name:OMOLABI
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 1:9200 FRANKLIN SQUARE DR
Mailing Address - Street 2:FRANKLIN WOODS CENTER
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4458
Mailing Address - Country:US
Mailing Address - Phone:410-391-2600
Mailing Address - Fax:
Practice Address - Street 1:9200 FRANKLIN SQUARE DR
Practice Address - Street 2:FRANKLIN WOODS CENTER
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4458
Practice Address - Country:US
Practice Address - Phone:410-391-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA02389224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant