Individual
ELIAS GATHENYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17475 DUGDALE DR, SOUTH BEND, IN 46635-1545
(574) 247-7500
Mailing address
15828 CLARENDON HILLS DR, GRANGER, IN 46530-7877
(574) 612-8394
Taxonomy
Speciality
Code
Description
License number
State
224ZF0002X
Feeding, Eating & Swallowing Occupational Therapy Assistant
Primary
32002567A
IN
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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