Provider Demographics
NPI:1396356614
Name:OKAFOR, CHUKWUMA JORDAN (COTA/L)
Entity type:Individual
Prefix:
First Name:CHUKWUMA
Middle Name:JORDAN
Last Name:OKAFOR
Suffix:
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WINDCLIFF DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-3814
Mailing Address - Country:US
Mailing Address - Phone:931-494-7920
Mailing Address - Fax:
Practice Address - Street 1:3201 WINDCLIFF DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-3814
Practice Address - Country:US
Practice Address - Phone:931-494-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002628224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant