Provider Demographics
NPI:1538630835
Name:SELBY, ZACHARY LEON (OTD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:LEON
Last Name:SELBY
Suffix:
Gender:M
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 BRADFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2174
Mailing Address - Country:US
Mailing Address - Phone:317-752-8854
Mailing Address - Fax:
Practice Address - Street 1:1521, 409 TYLER HOLMES DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967
Practice Address - Country:US
Practice Address - Phone:662-283-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-12
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist