Healthcare Provider Details

I. General information

NPI: 1629480710
Provider Name (Legal Business Name): OMOLOLU MAJEKODUNMI OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MASSACHUSETTS AVE NW STE 340
WASHINGTON DC
20016-4358
US

IV. Provider business mailing address

1710 W VIRGINIA AVE NE UNIT 101
WASHINGTON DC
20002-2338
US

V. Phone/Fax

Practice location:
  • Phone: 202-794-6820
  • Fax:
Mailing address:
  • Phone: 202-739-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number07155
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010000891
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: