Provider Demographics
NPI:1770137085
Name:IGBAROOLA, OLUWAGBOTEMI MOLAYO
Entity type:Individual
Prefix:
First Name:OLUWAGBOTEMI
Middle Name:MOLAYO
Last Name:IGBAROOLA
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 1:13205 TRIBUTE GREENFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6328
Mailing Address - Country:US
Mailing Address - Phone:202-717-3196
Mailing Address - Fax:
Practice Address - Street 1:13205 TRIBUTE GREENFIELDS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6328
Practice Address - Country:US
Practice Address - Phone:202-717-3196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician