Healthcare Provider Details

I. General information

NPI: 1194113381
Provider Name (Legal Business Name): MORIAM OLORUNOJE LPN, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 06/18/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WINDSOR EL CAMINO CARE CENTER 2540 CARMICHAEL WAY
CARMICHAEL CA
95608
US

IV. Provider business mailing address

151 JERSEY ST 5H
STATEN ISLAND NY
10301-1464
US

V. Phone/Fax

Practice location:
  • Phone: 347-366-1085
  • Fax:
Mailing address:
  • Phone: 718-727-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number319817
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT24190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: