Individual
ETINOSA OBADAGBONYI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(832) 264-1759
Mailing address
6600 VAN AALST BLVD, FORT MOORE, GA 31905-2102
(832) 264-1759
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
120260
TX
Other
Enumeration date
10/16/2020
Last updated
11/26/2023
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