Healthcare Provider Details

I. General information

NPI: 1982140547
Provider Name (Legal Business Name): COURTNEY SELBO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY CUMP

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17400 MONTEREY RD SUITE 2E
MORGAN HILL CA
95037-7318
US

IV. Provider business mailing address

698 N SANTA CRUZ AVE APT 26
LOS GATOS CA
95030-4302
US

V. Phone/Fax

Practice location:
  • Phone: 408-778-6200
  • Fax:
Mailing address:
  • Phone: 408-966-8571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number16171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: