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NPI Code Detail

MEDICARE: ELIAS GATHENYA

MEDICARE: ELIAS GATHENYA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224ZF0002XFeeding, Eating & Swallowing Occupational Therapy Assistant32002567AIN

General Provider Information

NPI Number : 1669935300
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIAS GATHENYA
Provider Business Mailing Address
First Line : 15828 CLARENDON HILLS DR
Second Line :
City : GRANGER
State : IN
Zip : 46530-7877
Country : US
Telephone Number : 574-612-8394
Fax Number :
Provider Business Practice Location Address
First Line : 17475 DUGDALE DR
Second Line :
City : SOUTH BEND
State : IN
Zip : 46635-1545
Country : US
Telephone Number : 574-247-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2019
Last Update Date : 04/10/2019

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Directions to “ ELIAS GATHENYA ” Practice Location

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