Provider Demographics
NPI:1386974459
Name:ADOKI, OTONYE SAMUEL
Entity type:Individual
Prefix:
First Name:OTONYE
Middle Name:SAMUEL
Last Name:ADOKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 NW 92ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-1317
Mailing Address - Country:US
Mailing Address - Phone:405-474-4517
Mailing Address - Fax:405-528-1802
Practice Address - Street 1:2220 N CLASSEN BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5809
Practice Address - Country:US
Practice Address - Phone:405-528-1748
Practice Address - Fax:405-528-1802
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200120060AMedicaid