Provider Demographics
NPI:1134775448
Name:ELMORE, KARA (LMT)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:ELMORE
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 1:29 SPRINGCREEK CT
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2380
Mailing Address - Country:US
Mailing Address - Phone:406-407-0565
Mailing Address - Fax:
Practice Address - Street 1:29 SPRINGCREEK CT
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2380
Practice Address - Country:US
Practice Address - Phone:406-407-0565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-15773225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTLMT-LMT-LIC-15773OtherSTATE LICENSE