Provider Demographics
NPI:1174336473
Name:AMES, ELIJAH (MT)
Entity type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:
Last Name:AMES
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 ABBOTT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1154
Mailing Address - Country:US
Mailing Address - Phone:207-907-2637
Mailing Address - Fax:207-990-2308
Practice Address - Street 1:63 ABBOTT HILL RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1154
Practice Address - Country:US
Practice Address - Phone:207-907-2637
Practice Address - Fax:207-990-2308
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT7581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist