Provider Demographics
NPI:1891817581
Name:SELTHUN, EMILY (ATC)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:
Last Name:SELTHUN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24583 362ND AVE
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:SD
Mailing Address - Zip Code:57355-6601
Mailing Address - Country:US
Mailing Address - Phone:605-680-0235
Mailing Address - Fax:605-234-7297
Practice Address - Street 1:300 S BYRON BLVD
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-9741
Practice Address - Country:US
Practice Address - Phone:605-234-7263
Practice Address - Fax:605-234-7297
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD02402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer