Provider Demographics
NPI:1003898586
Name:OKAFOR, MARK O (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:O
Last Name:OKAFOR
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 FAIRYSTONE PARK HWY
Mailing Address - Street 2:
Mailing Address - City:STANLEYTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:24168-3014
Mailing Address - Country:US
Mailing Address - Phone:276-622-3636
Mailing Address - Fax:
Practice Address - Street 1:935 FAIRYSTONE PARK HWY
Practice Address - Street 2:
Practice Address - City:STANLEYTOWN
Practice Address - State:VA
Practice Address - Zip Code:24168-3014
Practice Address - Country:US
Practice Address - Phone:276-622-3636
Practice Address - Fax:888-724-0268
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003394225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA743117794OtherMEDRISK
VA743117794OtherTRICARE