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NPI Code Detail

MEDICARE: MR. ADEYEM OLUROTIMI OLOYEDE COTA/L

MEDICARE: MR. ADEYEM OLUROTIMI OLOYEDE COTA/L
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
1224Z00000XOccupational Therapy Assistant155OK

General Provider Information

NPI Number : 1871267641
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ADEYEM OLUROTIMI OLOYEDE COTA/L
Provider Business Mailing Address
First Line : 753 NW FORT SILL BLVD
Second Line :
City : LAWTON
State : OK
Zip : 73507-5421
Country : US
Telephone Number : 580-357-6900
Fax Number :
Provider Business Practice Location Address
First Line : 753 NW FORT SILL BLVD
Second Line :
City : LAWTON
State : OK
Zip : 73507-5421
Country : US
Telephone Number : 580-357-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2021
Last Update Date : 08/05/2021

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