Provider Demographics
NPI:1003948258
Name:BLAIR, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9685 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3752
Mailing Address - Country:US
Mailing Address - Phone:703-978-8400
Mailing Address - Fax:703-978-9898
Practice Address - Street 1:9685 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3752
Practice Address - Country:US
Practice Address - Phone:703-978-8400
Practice Address - Fax:703-978-9898
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003289225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics