Provider Demographics
NPI:1326532995
Name:OKOYE, STANLEY T
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:T
Last Name:OKOYE
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 1:37470 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-5055
Mailing Address - Country:US
Mailing Address - Phone:313-412-7807
Mailing Address - Fax:
Practice Address - Street 1:35100 ANN ARBOR TRL
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3543
Practice Address - Country:US
Practice Address - Phone:734-522-1444
Practice Address - Fax:734-522-4690
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007533224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant