Provider Demographics
NPI:1790378461
Name:SELBY, CHRISTINA JOYCE (COTA)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JOYCE
Last Name:SELBY
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 1:2327 ARCHWOOD LN UNIT 125
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-6626
Mailing Address - Country:US
Mailing Address - Phone:805-813-3035
Mailing Address - Fax:
Practice Address - Street 1:2327 ARCHWOOD LN UNIT 125
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-6626
Practice Address - Country:US
Practice Address - Phone:805-813-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA886224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant