Basic Information
| Provider Information | |||||||||
| NPI: | 1790436384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ODUKOYA | ||||||||
| FirstName: | VIATAVIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8456 S LUELLA AVE | ||||||||
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| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606171952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303401428 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10137 GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601312548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474517590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2022 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 056.014578 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.