Provider Demographics
NPI:1073224291
Name:SELHORST, DODE
Entity Type:Individual
Prefix:
First Name:DODE
Middle Name:
Last Name:SELHORST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6936 STATE ROUTE 109
Mailing Address - Street 2:
Mailing Address - City:LEIPSIC
Mailing Address - State:OH
Mailing Address - Zip Code:45856-9433
Mailing Address - Country:US
Mailing Address - Phone:419-890-9763
Mailing Address - Fax:
Practice Address - Street 1:6936 STATE ROUTE 109
Practice Address - Street 2:
Practice Address - City:LEIPSIC
Practice Address - State:OH
Practice Address - Zip Code:45856-9433
Practice Address - Country:US
Practice Address - Phone:419-890-9763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care