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General NPI Number Information
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NPI Number | 1467184184
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Entity Type | Individual
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Provider Name | MARY OLAMIDE OMONIYI
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Gender | Female
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 07/05/2022
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Provider Practice Location Address
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Address Line | 10440 LITTLE PATUXENT PKWY
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City | COLUMBIA
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State | MD
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Zip | 21044-3561
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Country | US
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Telephone | 443-760-0819
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Fax |
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Provider Business Mailing Address
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Address Line | 205 RIVER WAY CT APT 201
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City | OWINGS MILLS
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State | MD
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Zip | 21117-5721
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Country | US
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Telephone | 443-760-0819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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