MEDICARE: TAIWO A AJIBADE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	224Z00000X	Occupational Therapy Assistant	32003209A	IN

General Provider Information

NPI Number	:	1386418606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAIWO A AJIBADE

Provider Business Mailing Address
First Line	:	8052 MATTERHORN LN APT D118
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-1153
Country	:	US
Telephone Number	:	708-501-1704
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 N TIBBS AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-3024
Country	:	US
Telephone Number	:	317-835-9016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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Directions to “ TAIWO A AJIBADE ” Practice Location

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