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NPI Code Detail

MEDICARE: CHAD SELBY

MEDICARE: CHAD SELBY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist5201005086MI

General Provider Information

NPI Number : 1629407275
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHAD SELBY
Provider Business Mailing Address
First Line : 4049 MORRISON RD NW
Second Line :
City : RAPID CITY
State : MI
Zip : 49676-9482
Country : US
Telephone Number : 906-250-8943
Fax Number :
Provider Business Practice Location Address
First Line : 2950 LAFRANIER RD
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-4918
Country : US
Telephone Number : 231-947-0506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2013
Last Update Date : 11/04/2013

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Directions to “ CHAD SELBY ” Practice Location

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