1437114972 NPI number — MS. ADETUTU OLUSOLA BALOGUN BS OCCUPATIONAL THER

Table of content: MS. ADETUTU OLUSOLA BALOGUN BS OCCUPATIONAL THER (NPI 1437114972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437114972 NPI number — MS. ADETUTU OLUSOLA BALOGUN BS OCCUPATIONAL THER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALOGUN
Provider First Name:
ADETUTU
Provider Middle Name:
OLUSOLA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BS OCCUPATIONAL THER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437114972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 OLYMPUS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TINLEY PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60477-4827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-614-1782
Provider Business Mailing Address Fax Number:
708-429-5868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 OLYMPUS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINLEY PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60477-4827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-614-1782
Provider Business Practice Location Address Fax Number:
708-429-5868
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225XP0200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com