Provider Demographics
NPI:1073221008
Name:ADESOPE, OLUWATOYOSI RUTH
Entity Type:Individual
Prefix:
First Name:OLUWATOYOSI
Middle Name:RUTH
Last Name:ADESOPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-4140
Mailing Address - Country:US
Mailing Address - Phone:740-644-7262
Mailing Address - Fax:
Practice Address - Street 1:65 N PINE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-4140
Practice Address - Country:US
Practice Address - Phone:740-644-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0091368251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091368Medicaid