Basic Information
| Provider Information | |||||||||
| NPI: | 1871664284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OKON | ||||||||
| FirstName: | OLUTOSIN | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2109 HOLIDAY RD | ||||||||
| Address2: | |||||||||
| City: | CORALVILLE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522412713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193586609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 402 10TH ST SE | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524032435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193659439 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 03550 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.