Provider Demographics
NPI:1588203202
Name:OSISAMI, OLUYEMI OLUBUNMI (OT)
Entity Type:Individual
Prefix:
First Name:OLUYEMI
Middle Name:OLUBUNMI
Last Name:OSISAMI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11015 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-5204
Mailing Address - Country:US
Mailing Address - Phone:240-281-9628
Mailing Address - Fax:
Practice Address - Street 1:11015 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-5204
Practice Address - Country:US
Practice Address - Phone:240-281-9628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08604225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist