Provider Demographics
NPI:1831388925
Name:GIKONYO, JOSPHAT WANJUKI I (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:MR
First Name:JOSPHAT
Middle Name:WANJUKI
Last Name:GIKONYO
Suffix:I
Gender:M
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 EARLY BLVD
Mailing Address - Street 2:
Mailing Address - City:EARLY
Mailing Address - State:TX
Mailing Address - Zip Code:76802-2130
Mailing Address - Country:US
Mailing Address - Phone:325-200-2805
Mailing Address - Fax:
Practice Address - Street 1:700 S OSTROM AVE
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448-3226
Practice Address - Country:US
Practice Address - Phone:254-629-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty