Provider Demographics
NPI:1891197109
Name:KANNIAPPAN, GOMATHI
Entity Type:Individual
Prefix:
First Name:GOMATHI
Middle Name:
Last Name:KANNIAPPAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S MARION RD
Mailing Address - Street 2:APT-204
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-0411
Mailing Address - Country:US
Mailing Address - Phone:605-413-4226
Mailing Address - Fax:
Practice Address - Street 1:1400 S MARION RD
Practice Address - Street 2:APT-204
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-0411
Practice Address - Country:US
Practice Address - Phone:605-413-4226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist