Basic Information
| Provider Information | |||||||||
| NPI: | 1265900047 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | MATHER | ||||||||
| FirstName: | CODY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6416 W 55TH ST | ||||||||
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| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571061957 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 920 4TH ST | ||||||||
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| City: | GARRETSON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 570302006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055943466 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2018 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1062 | SD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.