Basic Information
| Provider Information | |||||||||
| NPI: | 1538630835 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELBY | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | LEON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 859 BRADFORD AVE | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372042174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177528854 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1521, 409 TYLER HOLMES DR | ||||||||
| Address2: | |||||||||
| City: | WINONA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622834114 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2018 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT3602 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.