=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184529414
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALLISON N DEFOSSES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2026
-----------------------------------------------------
Last Update Date | 10/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 BROWNSWITCH RD STE 1
-----------------------------------------------------
City | SLIDELL
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70458-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-571-5355
-----------------------------------------------------
Fax | 504-389-4558
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2329 EDENBORN AVE
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70001-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-571-5355
-----------------------------------------------------
Fax | 504-389-4558
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT.0028027
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------