Provider Demographics
NPI:1003477571
Name:SEVAREID, ELISHA STARR (LMT)
Entity Type:Individual
Prefix:MS
First Name:ELISHA
Middle Name:STARR
Last Name:SEVAREID
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-0085
Mailing Address - Country:US
Mailing Address - Phone:808-443-1935
Mailing Address - Fax:
Practice Address - Street 1:338 KAUILA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2133
Practice Address - Country:US
Practice Address - Phone:808-443-1935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9005225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist