Provider Demographics
NPI:1114747029
Name:IBEJI, ONYEDIKACHI (OTD)
Entity type:Individual
Prefix:DR
First Name:ONYEDIKACHI
Middle Name:
Last Name:IBEJI
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7380 SW 27TH PL APT 2901
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1130
Mailing Address - Country:US
Mailing Address - Phone:954-939-1101
Mailing Address - Fax:
Practice Address - Street 1:4624 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6526
Practice Address - Country:US
Practice Address - Phone:954-939-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25585225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist