Provider Demographics
NPI:1356966196
Name:OTETUBI, OYINKANSOLA
Entity type:Individual
Prefix:
First Name:OYINKANSOLA
Middle Name:
Last Name:OTETUBI
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 1:7 WESTWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1822
Mailing Address - Country:US
Mailing Address - Phone:973-460-9411
Mailing Address - Fax:
Practice Address - Street 1:3809 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3259
Practice Address - Country:US
Practice Address - Phone:609-898-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist