Provider Demographics
NPI:1740794809
Name:OELBERG, SELINA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
Last Name:OELBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 CHAMBERLAIN DR APT 14
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5169
Mailing Address - Country:US
Mailing Address - Phone:901-409-4171
Mailing Address - Fax:
Practice Address - Street 1:36 BAZEBERRY RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7754
Practice Address - Country:US
Practice Address - Phone:901-758-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5286225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist