Provider Demographics
NPI:1578995015
Name:STAMPS, ELENA RAE (LMT)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:RAE
Last Name:STAMPS
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 1:1780 PATRICK WAY
Mailing Address - Street 2:APT. #4
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-4120
Mailing Address - Country:US
Mailing Address - Phone:502-836-8895
Mailing Address - Fax:
Practice Address - Street 1:923 COLLEGE ST
Practice Address - Street 2:SUITE C
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2195
Practice Address - Country:US
Practice Address - Phone:502-836-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4915225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist