Provider Demographics
NPI:1487548640
Name:DE LA MOTTE, ELIJAH JOHN (LMT)
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:JOHN
Last Name:DE LA MOTTE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:ELIJAH
Other - Middle Name:JOHN
Other - Last Name:DOIRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2306 WICKERSHAM LN APT 1400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-4706
Mailing Address - Country:US
Mailing Address - Phone:512-413-8333
Mailing Address - Fax:
Practice Address - Street 1:2316 MORELOS ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3452
Practice Address - Country:US
Practice Address - Phone:512-413-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist