Provider Demographics
NPI:1326349044
Name:PRATTE, ELAINE MICHELLE (LMT, CPT)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MICHELLE
Last Name:PRATTE
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SAINT JOHN STREET, SUITE 214
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3041
Mailing Address - Country:US
Mailing Address - Phone:207-871-7657
Mailing Address - Fax:207-347-7898
Practice Address - Street 1:222 SAINT JOHN ST STE 214
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3057
Practice Address - Country:US
Practice Address - Phone:207-871-7657
Practice Address - Fax:207-347-7898
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT2584174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMT2584OtherLMT - STATE OF ME