Provider Demographics
NPI:1407182850
Name:SELLERS, OMAR (USAW CERTIFIED COACH)
Entity Type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:SELLERS
Suffix:
Gender:M
Credentials:USAW CERTIFIED COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41087
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27629-1087
Mailing Address - Country:US
Mailing Address - Phone:919-208-3646
Mailing Address - Fax:919-740-3237
Practice Address - Street 1:120 GEORGE WILTON DR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-9205
Practice Address - Country:US
Practice Address - Phone:919-208-3646
Practice Address - Fax:919-740-3237
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer