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NPI Code Detail

MEDICARE: MR. OLUREMI MICHAEL OLAITAN BCBA

MEDICARE:  MR. OLUREMI MICHAEL OLAITAN  BCBA
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
1103K00000XBehavior Analyst1-22-58511MD

General Provider Information

NPI Number : 1851033997
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OLUREMI MICHAEL OLAITAN BCBA
Provider Business Mailing Address
First Line : 4741 COLONEL ASHTON PL
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-2881
Country : US
Telephone Number : 301-379-9654
Fax Number :
Provider Business Practice Location Address
First Line : 4741 COLONEL ASHTON PL
Second Line :
City : UPPER MARLBORO
State : MD
Zip : 20772-2881
Country : US
Telephone Number : 301-379-9654
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2022
Last Update Date : 04/09/2022

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