Healthcare Provider Details

I. General information

NPI: 1932881976
Provider Name (Legal Business Name): MADELINE MARIE SELHORST OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADELINE HOLBROOK OTR/L

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N EAST ST
PICKERINGTON OH
43147-1585
US

IV. Provider business mailing address

955 LIBERTY DR
LANCASTER OH
43130-8045
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-2110
  • Fax:
Mailing address:
  • Phone: 740-653-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT012284
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: