Healthcare Provider Details

I. General information

NPI: 1073474417
Provider Name (Legal Business Name): IZEBHOKUN OKOH RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 REDFIELD LN
COPLEY OH
44321-2837
US

IV. Provider business mailing address

726 BERWICK CT
COPLEY OH
44321-1495
US

V. Phone/Fax

Practice location:
  • Phone: 678-451-3012
  • Fax:
Mailing address:
  • Phone: 678-451-3012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: