Provider Demographics
NPI:1548721921
Name:OLAJIDE-OGUNYE, OMOLARA (OTR)
Entity type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:OLAJIDE-OGUNYE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:OMOLARA
Other - Middle Name:
Other - Last Name:OGUNYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:49 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-1672
Mailing Address - Country:US
Mailing Address - Phone:609-489-1389
Mailing Address - Fax:
Practice Address - Street 1:250 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-2456
Practice Address - Country:US
Practice Address - Phone:805-494-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19567225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist