Healthcare Provider Details

I. General information

NPI: 1366165516
Provider Name (Legal Business Name): REBECCA OLUKOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA THOMSON

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WINGED FOOT DR
WESTMINSTER MD
21158-4145
US

IV. Provider business mailing address

354 WINGED FOOT DR
WESTMINSTER MD
21158-4145
US

V. Phone/Fax

Practice location:
  • Phone: 443-360-8772
  • Fax:
Mailing address:
  • Phone: 443-360-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: