Basic Information
| Provider Information | |||||||||
| NPI: | 1790818904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OGUEKWE | ||||||||
| FirstName: | CHIMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | PROSPECT PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190762322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105866262 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | PROSPECT PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190762322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105866262 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | RT003908 | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 225X00000X | OC012241 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.