Provider Demographics
NPI:1194432047
Name:TEMIDAYO, OLUBUMI FABIYI
Entity type:Individual
Prefix:
First Name:OLUBUMI
Middle Name:FABIYI
Last Name:TEMIDAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ONAOLA
Other - Middle Name:FABIYI
Other - Last Name:TEMIDAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6202 CARYHURST DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-3113
Mailing Address - Country:US
Mailing Address - Phone:301-728-2120
Mailing Address - Fax:
Practice Address - Street 1:6202 CARYHURST DR
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-3113
Practice Address - Country:US
Practice Address - Phone:301-728-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225XR0403X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No225XR0403XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistDriving and Community Mobility