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General NPI Number Information
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NPI Number | 1487548640
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Entity Type | Individual
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Provider Name | ELIJAH JOHN DE LA MOTTE LMT
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 2316 MORELOS ST
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City | AUSTIN
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State | TX
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Zip | 78702-3452
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Country | US
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Telephone | 512-413-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 2306 WICKERSHAM LN APT 1400
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City | AUSTIN
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State | TX
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Zip | 78741-4706
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Country | US
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Telephone | 512-413-8333
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 131218
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License Number State | TX
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