Provider Demographics
NPI:1962681601
Name:KOTEY, OMONIKE R
Entity Type:Individual
Prefix:
First Name:OMONIKE
Middle Name:R
Last Name:KOTEY
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 1:5300 PASEO RANCHO CASTILLA
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-4300
Mailing Address - Country:US
Mailing Address - Phone:949-633-7967
Mailing Address - Fax:
Practice Address - Street 1:5300 PASEO RANCHO CASTILLA
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-4300
Practice Address - Country:US
Practice Address - Phone:949-633-7967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner