Provider Demographics
NPI:1750789004
Name:ADEPOJU, OLUWASEGUN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:OLUWASEGUN
Middle Name:
Last Name:ADEPOJU
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 AGATE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5301
Mailing Address - Country:US
Mailing Address - Phone:646-496-5636
Mailing Address - Fax:
Practice Address - Street 1:1912 AGATE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5301
Practice Address - Country:US
Practice Address - Phone:646-496-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11437314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility