Active NPI
Elias Gathenya
- Feeding, Eating & Swallowing Occupational Therapy Assistant
- South Bend, IN
National Provider Identifier
1669935300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Feeding, Eating & Swallowing Occupational Therapy Assistant
- License
- 32002567A
- Practice address
- 17475 Dugdale Dr
South Bend, IN 46635-1545 - Phone
- (574) 247-7500
- NPI assigned
- Apr 10, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Feeding, Eating & Swallowing Occupational Therapy Assistant | 224ZF0002X | 32002567A | IN | Primary |
Addresses
Primary practice location
17475 Dugdale Dr
South Bend, IN 46635-1545
Mailing address
15828 Clarendon Hills Dr
Granger, IN 46530-7877
Phone (574) 612-8394
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32002567A | IN | MD | Feeding, Eating & Swallowing Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554854400000",
"number": "1669935300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15828 CLARENDON HILLS DR",
"city": "GRANGER",
"state": "IN",
"postal_code": "465307877",
"telephone_number": "574-612-8394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17475 DUGDALE DR",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466351545",
"telephone_number": "574-247-7500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GATHENYA",
"first_name": "ELIAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-10",
"last_updated": "2019-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "224ZF0002X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant, Feeding, Eating & Swallowing",
"state": "IN",
"license": "32002567A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.