Provider Demographics
NPI:1629664750
Name:AJIBADE, KEHINDE
Entity Type:Individual
Prefix:
First Name:KEHINDE
Middle Name:
Last Name:AJIBADE
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 1:2710 ROUTH CREEK PKWY APT 7105
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-0170
Mailing Address - Country:US
Mailing Address - Phone:708-501-1206
Mailing Address - Fax:
Practice Address - Street 1:2710 ROUTH CREEK PKWY APT 7105
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-0170
Practice Address - Country:US
Practice Address - Phone:708-501-1206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant