Provider Demographics
NPI:1740995653
Name:AYANDARE, BUKOLA CHARLES (COTA)
Entity type:Individual
Prefix:
First Name:BUKOLA
Middle Name:CHARLES
Last Name:AYANDARE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1180 MADISON CHASE APT 6
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3297
Mailing Address - Country:US
Mailing Address - Phone:561-223-6593
Mailing Address - Fax:
Practice Address - Street 1:1180 MADISON CHASE APT 6
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3297
Practice Address - Country:US
Practice Address - Phone:561-223-6593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant