Provider Demographics
NPI:1982140547
Name:SELBO, COURTNEY (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:SELBO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:CUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:698 N SANTA CRUZ AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-4302
Mailing Address - Country:US
Mailing Address - Phone:408-966-8571
Mailing Address - Fax:
Practice Address - Street 1:17400 MONTEREY RD
Practice Address - Street 2:SUITE 2E
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-7318
Practice Address - Country:US
Practice Address - Phone:408-778-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16171225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics