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NPI Code Detail

MEDICARE: MS. ADETUTU OLUSOLA BALOGUN BS OCCUPATIONAL THER

MEDICARE: MS. ADETUTU OLUSOLA BALOGUN BS OCCUPATIONAL THER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistIL
2225XP0200XPediatric Occupational TherapistIL

General Provider Information

NPI Number : 1437114972
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ADETUTU OLUSOLA BALOGUN BS OCCUPATIONAL THER
Provider Business Mailing Address
First Line : 2 OLYMPUS DR
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-4827
Country : US
Telephone Number : 708-614-1782
Fax Number : 708-429-5868
Provider Business Practice Location Address
First Line : 2 OLYMPUS DR
Second Line :
City : TINLEY PARK
State : IL
Zip : 60477-4827
Country : US
Telephone Number : 708-614-1782
Fax Number : 708-429-5868
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2006
Last Update Date : 09/11/2025

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