Provider Demographics
NPI:1003967936
Name:OSHIKANLU, BOLAJOKO (OTR)
Entity Type:Individual
Prefix:MS
First Name:BOLAJOKO
Middle Name:
Last Name:OSHIKANLU
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHESTNUT RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1006
Mailing Address - Country:US
Mailing Address - Phone:516-680-4508
Mailing Address - Fax:631-957-1977
Practice Address - Street 1:16 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1006
Practice Address - Country:US
Practice Address - Phone:516-680-4508
Practice Address - Fax:631-957-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10840-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000088713OtherGHI
NY000000088713OtherGHI