Provider Demographics
NPI:1124555750
Name:KOTOYE, CHRISTIAN OLUKAYODE
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:OLUKAYODE
Last Name:KOTOYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 NORTHWIND DR APT 504
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5060
Mailing Address - Country:US
Mailing Address - Phone:989-513-3094
Mailing Address - Fax:
Practice Address - Street 1:3887 OKEMOS RD STE A1
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3663
Practice Address - Country:US
Practice Address - Phone:517-992-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-13
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician