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General NPI Number Information
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NPI Number | 1669935300
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Entity Type | Individual
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Provider Name | ELIAS GATHENYA
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Gender | Male
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 17475 DUGDALE DR
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City | SOUTH BEND
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State | IN
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Zip | 46635-1545
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Country | US
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Telephone | 574-247-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 15828 CLARENDON HILLS DR
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City | GRANGER
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State | IN
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Zip | 46530-7877
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Country | US
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Telephone | 574-612-8394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224ZF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapy Assistant
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License Number | 32002567A
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License Number State | IN
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