Provider Demographics
NPI:1437995453
Name:AFOLABI, OLATAYO S
Entity type:Individual
Prefix:
First Name:OLATAYO
Middle Name:S
Last Name:AFOLABI
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 1:402 MOLLY LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-8972
Mailing Address - Country:US
Mailing Address - Phone:708-501-1613
Mailing Address - Fax:
Practice Address - Street 1:728 TROY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-1559
Practice Address - Country:US
Practice Address - Phone:708-501-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home