Provider Demographics
NPI:1295406999
Name:OGUNNAIKE, OLAWALE DANIELS
Entity type:Individual
Prefix:
First Name:OLAWALE
Middle Name:DANIELS
Last Name:OGUNNAIKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 W AIRPORT BLVD APT 8106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77085-5003
Mailing Address - Country:US
Mailing Address - Phone:832-670-5316
Mailing Address - Fax:
Practice Address - Street 1:4911 W AIRPORT BLVD APT 8106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77085-5003
Practice Address - Country:US
Practice Address - Phone:832-670-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216792224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant