Healthcare Provider Details

I. General information

NPI: 1326228958
Provider Name (Legal Business Name): MS. ODILI OKOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1378 RIVER ST STE A
HYDE PARK MA
02136-2121
US

IV. Provider business mailing address

1378 RIVER ST STE A
HYDE PARK MA
02136-2121
US

V. Phone/Fax

Practice location:
  • Phone: 781-492-7722
  • Fax: 617-361-1700
Mailing address:
  • Phone: 781-492-7722
  • Fax: 617-361-1700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: