Provider Demographics
NPI:1720762677
Name:SELDERS, RESHELLS
Entity Type:Individual
Prefix:
First Name:RESHELLS
Middle Name:
Last Name:SELDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2766
Mailing Address - Country:US
Mailing Address - Phone:225-650-5964
Mailing Address - Fax:
Practice Address - Street 1:4258 HONEYSUCKLE DR
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-2766
Practice Address - Country:US
Practice Address - Phone:225-650-5964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 224Z00000X
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No171400000XOther Service ProvidersHealth & Wellness Coach
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant