Provider Demographics
NPI:1376109363
Name:AWOSIKA, ALABA IFEOLUWA
Entity type:Individual
Prefix:
First Name:ALABA
Middle Name:IFEOLUWA
Last Name:AWOSIKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 BEAR PAW DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-2885
Mailing Address - Country:US
Mailing Address - Phone:219-487-4393
Mailing Address - Fax:
Practice Address - Street 1:2716 BEAR PAW DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-2885
Practice Address - Country:US
Practice Address - Phone:219-487-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32003203A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist