Provider Demographics
NPI:1174822852
Name:SELEY, KATHERINE ANN
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ANN
Last Name:SELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 S WOODSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-3258
Mailing Address - Country:US
Mailing Address - Phone:719-547-1851
Mailing Address - Fax:
Practice Address - Street 1:201 LAMKIN ST UNIT 101B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3476
Practice Address - Country:US
Practice Address - Phone:719-253-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002694224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant