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General NPI Number Information
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NPI Number | 1326349044
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Entity Type | Individual
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Provider Name | ELAINE MICHELLE PRATTE LMT, CPT
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Gender | Female
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 222 SAINT JOHN ST STE 214
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City | PORTLAND
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State | ME
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Zip | 04102-3057
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Country | US
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Telephone | 207-871-7657
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Fax | 207-347-7898
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Provider Business Mailing Address
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Address Line | 222 SAINT JOHN STREET, SUITE 214
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City | PORTLAND
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State | ME
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Zip | 04102-3041
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Country | US
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Telephone | 207-871-7657
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Fax | 207-347-7898
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MT2584
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License Number State | ME
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