Provider Demographics
NPI:1124561915
Name:SELMAN, JENNIFER NICOLE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:SELMAN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 CR 338
Mailing Address - Street 2:
Mailing Address - City:JEWETT
Mailing Address - State:TX
Mailing Address - Zip Code:75846
Mailing Address - Country:US
Mailing Address - Phone:936-204-1072
Mailing Address - Fax:
Practice Address - Street 1:2333 MANOR DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-1907
Practice Address - Country:US
Practice Address - Phone:979-821-7327
Practice Address - Fax:979-823-9008
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214283224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant