Provider Demographics
NPI:1619563111
Name:SOKOYA, NOSIFAT OMOLARA
Entity Type:Individual
Prefix:
First Name:NOSIFAT
Middle Name:OMOLARA
Last Name:SOKOYA
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 1:5026 N SPRINGFIELD AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-6125
Mailing Address - Country:US
Mailing Address - Phone:773-679-8392
Mailing Address - Fax:
Practice Address - Street 1:9834 S HAMLIN AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3363
Practice Address - Country:US
Practice Address - Phone:708-921-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.013832225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist