Provider Demographics
NPI:1194190660
Name:OLADIRAN-ADEDEJI, OLUBUSOLA ABIDEMI (MSOTR/L)
Entity Type:Individual
Prefix:
First Name:OLUBUSOLA
Middle Name:ABIDEMI
Last Name:OLADIRAN-ADEDEJI
Suffix:
Gender:F
Credentials:MSOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 EQUINE RUN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-3036
Mailing Address - Country:US
Mailing Address - Phone:973-687-7246
Mailing Address - Fax:
Practice Address - Street 1:3 EQUINE RUN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3036
Practice Address - Country:US
Practice Address - Phone:973-687-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00585400225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist