Healthcare Provider Details

I. General information

NPI: 1831720267
Provider Name (Legal Business Name): OLADAPO OLAYINKA KUKOYI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MAY ST
CALUMET CITY IL
60409-4415
US

IV. Provider business mailing address

751 MAY ST
CALUMET CITY IL
60409-4415
US

V. Phone/Fax

Practice location:
  • Phone: 708-743-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056012505
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: