Provider Demographics
NPI:1922296748
Name:STATHIS, JAIME ALEXIS (CMT)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:ALEXIS
Last Name:STATHIS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 S RESERVE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6455
Mailing Address - Country:US
Mailing Address - Phone:406-721-9080
Mailing Address - Fax:406-721-9008
Practice Address - Street 1:1900 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6455
Practice Address - Country:US
Practice Address - Phone:406-721-9080
Practice Address - Fax:406-721-9008
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist