Healthcare Provider Details

I. General information

NPI: 1982256152
Provider Name (Legal Business Name): MRS. OLUWASEYI M. OPARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 07/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 E HAMPTON ST
STOCKTON CA
95204-5519
US

IV. Provider business mailing address

442 E HAMPTON ST
STOCKTON CA
95204-5519
US

V. Phone/Fax

Practice location:
  • Phone: 877-787-3422
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: