Provider Demographics
NPI:1356099709
Name:LADOTUN, RUKAYAT ADEBUSOLA
Entity type:Individual
Prefix:
First Name:RUKAYAT
Middle Name:ADEBUSOLA
Last Name:LADOTUN
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 1:1589 E 95TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5413
Mailing Address - Country:US
Mailing Address - Phone:347-909-2461
Mailing Address - Fax:
Practice Address - Street 1:1589 E 95TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5413
Practice Address - Country:US
Practice Address - Phone:347-909-2461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026609-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026609-1OtherLICENSE