Provider Demographics
NPI:1194487801
Name:FOLABI, GANIYU (COTA)
Entity Type:Individual
Prefix:
First Name:GANIYU
Middle Name:
Last Name:FOLABI
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9014 PATTERSON AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6150
Mailing Address - Country:US
Mailing Address - Phone:804-243-9937
Mailing Address - Fax:
Practice Address - Street 1:6701 IRONBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1469
Practice Address - Country:US
Practice Address - Phone:804-318-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002376224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant