Provider Demographics
NPI:1164064770
Name:OLAGOKE, OLUREMI OLATORO
Entity Type:Individual
Prefix:
First Name:OLUREMI
Middle Name:OLATORO
Last Name:OLAGOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REMI
Other - Middle Name:
Other - Last Name:OLAGOKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA SLP- CF
Mailing Address - Street 1:9330 BROADWAY ST STE 312
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7895
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9330 BROADWAY ST STE 312
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7895
Practice Address - Country:US
Practice Address - Phone:832-856-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116337235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist