Provider Demographics
NPI:1912873951
Name:MATLOGA, OMOLEMO JOSEPHINE (OTD)
Entity type:Individual
Prefix:
First Name:OMOLEMO
Middle Name:JOSEPHINE
Last Name:MATLOGA
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9923 OXBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2975
Mailing Address - Country:US
Mailing Address - Phone:301-350-8680
Mailing Address - Fax:
Practice Address - Street 1:1901 INDEPENDENCE AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-1733
Practice Address - Country:US
Practice Address - Phone:301-350-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOT210002498225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist