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General NPI Number Information
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NPI Number | 1841307212
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Entity Type | Individual
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Provider Name | MR. THOMAS AMOS ELLIOTT
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | POB 1191 1113 DAINGERFIELD ST
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City | TAPPAHANNOCK
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State | VA
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Zip | 22560-1191
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Country | US
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Telephone | 703-861-4997
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Fax | 804-445-1914
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Provider Business Mailing Address
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Address Line | POB 1191 1113 DAINGERFIELD STREET
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City | TAPPAHANNOCK
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State | VA
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Zip | 22560-1191
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Country | US
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Telephone | 571-501-8865
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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 | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 2705057306
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License Number State | VA
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