Provider Demographics
NPI:1851033997
Name:OLAITAN, OLUREMI MICHAEL (BCBA)
Entity Type:Individual
Prefix:MR
First Name:OLUREMI
Middle Name:MICHAEL
Last Name:OLAITAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4741 COLONEL ASHTON PL
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2881
Mailing Address - Country:US
Mailing Address - Phone:301-379-9654
Mailing Address - Fax:
Practice Address - Street 1:4741 COLONEL ASHTON PL
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2881
Practice Address - Country:US
Practice Address - Phone:301-379-9654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-22-58511103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty