Provider Demographics
NPI:1336552884
Name:SELAN, BRENDA (OTR/L)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:SELAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 MONTGOMERY ST
Mailing Address - Street 2:CUSTER REGIONAL HOSPITAL
Mailing Address - City:CUSTER
Mailing Address - State:SD
Mailing Address - Zip Code:57730-1304
Mailing Address - Country:US
Mailing Address - Phone:605-673-9470
Mailing Address - Fax:605-673-4954
Practice Address - Street 1:1039 MONTGOMERY ST
Practice Address - Street 2:1039 MONTGOMERY ST
Practice Address - City:CUSTER
Practice Address - State:SD
Practice Address - Zip Code:57730-1304
Practice Address - Country:US
Practice Address - Phone:605-673-9470
Practice Address - Fax:605-673-4954
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist