Provider Demographics
NPI:1699569665
Name:EMEKA, OTAVIAN KENECHI
Entity type:Individual
Prefix:
First Name:OTAVIAN
Middle Name:KENECHI
Last Name:EMEKA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BOXWOOD CREST CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5975
Mailing Address - Country:US
Mailing Address - Phone:217-316-3132
Mailing Address - Fax:
Practice Address - Street 1:16 BOXWOOD CREST CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5975
Practice Address - Country:US
Practice Address - Phone:217-316-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician