Provider Demographics
NPI:1578319877
Name:OLALEYE, BOSE FELICITY
Entity Type:Individual
Prefix:
First Name:BOSE
Middle Name:FELICITY
Last Name:OLALEYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 LONGFELLOW ST NW APT 301
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3094
Mailing Address - Country:US
Mailing Address - Phone:909-435-1574
Mailing Address - Fax:
Practice Address - Street 1:9801 GEORGIA AVE STE 111
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-593-1559
Practice Address - Fax:301-593-1559
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist