Provider Demographics
NPI:1104043637
Name:OLADIMEJI-STEVENS, OLAYINKA (PT)
Entity Type:Individual
Prefix:MR
First Name:OLAYINKA
Middle Name:
Last Name:OLADIMEJI-STEVENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 LAKE FOREST CT
Mailing Address - Street 2:
Mailing Address - City:FINKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21048-2621
Mailing Address - Country:US
Mailing Address - Phone:410-549-2339
Mailing Address - Fax:
Practice Address - Street 1:4328 LAKE FOREST CT
Practice Address - Street 2:
Practice Address - City:FINKSBURG
Practice Address - State:MD
Practice Address - Zip Code:21048-2621
Practice Address - Country:US
Practice Address - Phone:410-549-2339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18804225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist