Provider Demographics
NPI:1578684098
Name:OYENIYA, IYABO OMOWUNMI (PT)
Entity Type:Individual
Prefix:
First Name:IYABO
Middle Name:OMOWUNMI
Last Name:OYENIYA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 MURPHY MILL RD APT B
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4538
Mailing Address - Country:US
Mailing Address - Phone:229-924-7150
Mailing Address - Fax:229-924-7150
Practice Address - Street 1:219 MURPHY MILL RD APT B
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4538
Practice Address - Country:US
Practice Address - Phone:229-924-7150
Practice Address - Fax:229-924-7150
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007709373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist