Provider Demographics
NPI:1083105688
Name:MOLOHON, ELIJAH JAMES (LMP)
Entity Type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:JAMES
Last Name:MOLOHON
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 FERRY AVE APT C107
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6583
Mailing Address - Country:US
Mailing Address - Phone:360-481-1599
Mailing Address - Fax:
Practice Address - Street 1:2930 NEWMARKET ST STE 115
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-3870
Practice Address - Country:US
Practice Address - Phone:360-656-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-20
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60682418225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist