Provider Demographics
NPI:1750984654
Name:OLAYIWOLA, REKIAT
Entity type:Individual
Prefix:
First Name:REKIAT
Middle Name:
Last Name:OLAYIWOLA
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 1:5311 NORTHFIELD RD STE 410
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1135
Mailing Address - Country:US
Mailing Address - Phone:216-402-9945
Mailing Address - Fax:
Practice Address - Street 1:5311 NORTHFIELD ROAD STE 410 ROOM 2
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1135
Practice Address - Country:US
Practice Address - Phone:216-402-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0323707Medicaid
OH1831359OtherDODD