Provider Demographics
NPI:1700018637
Name:SELIN, MARIA D (OTA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:D
Last Name:SELIN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23447 RADIENT CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-5891
Mailing Address - Country:US
Mailing Address - Phone:561-479-3360
Mailing Address - Fax:
Practice Address - Street 1:23315 BLUE WATER CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-7053
Practice Address - Country:US
Practice Address - Phone:561-368-1033
Practice Address - Fax:561-955-9640
Is Sole Proprietor?:No
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10626224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant