Provider Demographics
NPI:1811073976
Name:UWA, IZIEGBE CAROLINE (MS)
Entity type:Individual
Prefix:MISS
First Name:IZIEGBE
Middle Name:CAROLINE
Last Name:UWA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:IZIEGBE
Other - Middle Name:
Other - Last Name:OJO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6833
Mailing Address - Country:US
Mailing Address - Phone:516-425-2371
Mailing Address - Fax:
Practice Address - Street 1:15 MARYLAND ST
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6833
Practice Address - Country:US
Practice Address - Phone:516-425-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0134671225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist