Healthcare Provider Details

I. General information

NPI: 1164621165
Provider Name (Legal Business Name): EKEI EKPO-ITA MBUKPA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 05/06/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 SCHICKASAW TRAL #1167
ORLANDO FL
32825-2730
US

IV. Provider business mailing address

461 KIRK RD APT 1A
WEST PALM BEACH FL
33406-2931
US

V. Phone/Fax

Practice location:
  • Phone: 832-820-7229
  • Fax:
Mailing address:
  • Phone: 832-820-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number029649
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number006520-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number018744
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number56490
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: