MEDICARE: ALWAJUDAT LAWAL OTR

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	225X00000X	Occupational Therapist	0119009331	MN

General Provider Information

NPI Number	:	1881472983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALWAJUDAT LAWAL OTR

Provider Business Mailing Address
First Line	:	2111 WAKEFIELD AVE
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2521
Country	:	US
Telephone Number	:	312-956-5651
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 DIAMOND DR
Second Line	:
City	:	NORTH DINWIDDIE
State	:	VA
Zip	:	23803-7495
Country	:	US
Telephone Number	:	804-518-0780
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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