Healthcare Provider Details

I. General information

NPI: 1265357768
Provider Name (Legal Business Name): OLUWASEYI OSHO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9102 EMERSONS REACH
COLUMBIA MD
21045-4012
US

IV. Provider business mailing address

9102 EMERSONS REACH
COLUMBIA MD
21045-4012
US

V. Phone/Fax

Practice location:
  • Phone: 667-925-2666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number82525570
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: