Provider Demographics
NPI:1821024183
Name:SELLECK, HAROLD ARTHUR (ATC/L)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:ARTHUR
Last Name:SELLECK
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 GREEN PINE BLVD
Mailing Address - Street 2:UNIT H1
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7903
Mailing Address - Country:US
Mailing Address - Phone:561-309-1615
Mailing Address - Fax:
Practice Address - Street 1:1108 GREEN PINE BLVD
Practice Address - Street 2:UNIT H1
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-7903
Practice Address - Country:US
Practice Address - Phone:561-309-1615
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer