Provider Demographics
NPI:1720658008
Name:SELDON, MAURICE JR (OTA)
Entity Type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:
Last Name:SELDON
Suffix:JR
Gender:M
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 ANNTANA AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4203
Mailing Address - Country:US
Mailing Address - Phone:410-591-4456
Mailing Address - Fax:
Practice Address - Street 1:4314 ANNTANA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-4203
Practice Address - Country:US
Practice Address - Phone:410-591-4456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant