Provider Demographics
NPI:1871267641
Name:OLOYEDE, ADEYEM OLUROTIMI (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:ADEYEM
Middle Name:OLUROTIMI
Last Name:OLOYEDE
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 NW FORT SILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-5421
Mailing Address - Country:US
Mailing Address - Phone:580-357-6900
Mailing Address - Fax:
Practice Address - Street 1:753 NW FORT SILL BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-5421
Practice Address - Country:US
Practice Address - Phone:580-357-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK155224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant