Provider Demographics
NPI:1336814037
Name:SELAH THERAPEUTICS, LLC
Entity Type:Organization
Organization Name:SELAH THERAPEUTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EZEKIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:205-249-1857
Mailing Address - Street 1:8417 CROSSLAND LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8485
Mailing Address - Country:US
Mailing Address - Phone:205-249-1857
Mailing Address - Fax:334-612-7172
Practice Address - Street 1:8417 CROSSLAND LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8485
Practice Address - Country:US
Practice Address - Phone:205-249-1857
Practice Address - Fax:334-612-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty