Provider Demographics
NPI:1306153457
Name:OKOCHA, ETHEL FAY (M OF ED, GCDF)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:FAY
Last Name:OKOCHA
Suffix:
Gender:F
Credentials:M OF ED, GCDF
Other - Prefix:MRS
Other - First Name:ETHEL
Other - Middle Name:FAY
Other - Last Name:OWUSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2305 E 70TH PL
Mailing Address - Street 2:UNIT 316E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2282
Mailing Address - Country:US
Mailing Address - Phone:773-643-2714
Mailing Address - Fax:773-643-2714
Practice Address - Street 1:2305 E 70TH PL
Practice Address - Street 2:UNIT 316E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-2282
Practice Address - Country:US
Practice Address - Phone:773-643-2714
Practice Address - Fax:773-643-2714
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist