Provider Demographics
NPI:1649435819
Name:ADEKOLA, AJIBOLA (OTR/L)
Entity type:Individual
Prefix:
First Name:AJIBOLA
Middle Name:
Last Name:ADEKOLA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BORDIC RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3602
Mailing Address - Country:US
Mailing Address - Phone:484-769-4205
Mailing Address - Fax:
Practice Address - Street 1:125 BORDIC RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3602
Practice Address - Country:US
Practice Address - Phone:484-769-4205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist