Provider Demographics
NPI:1942653761
Name:ENOMA-YUSUF, OLUMAYOWA (, OTD OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:OLUMAYOWA
Middle Name:
Last Name:ENOMA-YUSUF
Suffix:
Gender:F
Credentials:, OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12164 E DOMNITCH DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-6873
Mailing Address - Country:US
Mailing Address - Phone:301-254-0883
Mailing Address - Fax:
Practice Address - Street 1:1141 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1871
Practice Address - Country:US
Practice Address - Phone:301-254-0883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-16
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTH007661225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation