Provider Demographics
NPI:1679503882
Name:DEFLEY, MICHELE (OTR, CHT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DEFLEY
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6080 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3912
Mailing Address - Country:US
Mailing Address - Phone:817-731-9331
Mailing Address - Fax:817-731-9882
Practice Address - Street 1:6080 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3912
Practice Address - Country:US
Practice Address - Phone:817-731-9331
Practice Address - Fax:817-731-9882
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106952225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1256670001OtherCIGNA DME PROVIDER
TX752570786OtherFEIN
TX1021100149OtherHAND THERAPY CERTIFICATE
8T6760OtherBCBS TX
TX1256670001Medicare NSC
8T6760OtherBCBS TX