Healthcare Provider Details

I. General information

NPI: 1215557822
Provider Name (Legal Business Name): MRS. ELIZABETH AJOKE ONAYIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 MARLEY STATION RD
GLEN BURNIE MD
21060-7717
US

IV. Provider business mailing address

516 MARLEY STATION RD
GLEN BURNIE MD
21060-7717
US

V. Phone/Fax

Practice location:
  • Phone: 443-219-2882
  • Fax: 443-219-2882
Mailing address:
  • Phone: 443-219-2882
  • Fax: 443-219-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberR4130
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR4130
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberR4130
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR4130
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2279H0200X
TaxonomyHome Health Registered Respiratory Therapist
License NumberR4130
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberR4130
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: