Provider Demographics
NPI:1558845008
Name:NIEHOFF, ALICE (DT)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:NIEHOFF
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7722 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1854
Mailing Address - Country:US
Mailing Address - Phone:502-468-6479
Mailing Address - Fax:
Practice Address - Street 1:1099 MARCI LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9062
Practice Address - Country:US
Practice Address - Phone:812-951-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist