Provider Demographics
NPI:1497831853
Name:EKUNDAYO, JOHN KENN (OTA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KENN
Last Name:EKUNDAYO
Suffix:
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ORIOLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110
Mailing Address - Country:US
Mailing Address - Phone:931-507-6048
Mailing Address - Fax:
Practice Address - Street 1:928 OLD SMITHVILLE RD
Practice Address - Street 2:NHC MCMINNVILLE
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-473-8431
Practice Address - Fax:931-473-3941
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant