Provider Demographics
NPI:1326257866
Name:DEFOUR, ALICE M (MS, OTR)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:M
Last Name:DEFOUR
Suffix:
Gender:F
Credentials:MS, OTR
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:M
Other - Last Name:BELSCHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR
Mailing Address - Street 1:694 RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7530
Mailing Address - Country:US
Mailing Address - Phone:317-272-7040
Mailing Address - Fax:
Practice Address - Street 1:75 S COUNTY ROAD 400 E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9410
Practice Address - Country:US
Practice Address - Phone:317-745-5184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31001059A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist