Provider Demographics
NPI:1245688704
Name:OSIGBEME, OMOLARA
Entity type:Individual
Prefix:
First Name:OMOLARA
Middle Name:
Last Name:OSIGBEME
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 1:14453 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-1818
Mailing Address - Country:US
Mailing Address - Phone:708-228-4397
Mailing Address - Fax:
Practice Address - Street 1:14453 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DOLTON
Practice Address - State:IL
Practice Address - Zip Code:60419-1818
Practice Address - Country:US
Practice Address - Phone:708-228-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1181512279H0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredHome Health