Provider Demographics
NPI:1164621165
Name:MBUKPA, EKEI EKPO-ITA (OTR)
Entity type:Individual
Prefix:
First Name:EKEI
Middle Name:EKPO-ITA
Last Name:MBUKPA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 KIRK RD APT 1A
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-2931
Mailing Address - Country:US
Mailing Address - Phone:832-820-7229
Mailing Address - Fax:
Practice Address - Street 1:2212 SCHICKASAW TRAL #1167
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-2730
Practice Address - Country:US
Practice Address - Phone:832-820-7229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029649163W00000X
NY006520-1224Z00000X
NY018744225X00000X
WY56490363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist