Individual
SELENA BACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1905 PINE ST, SANDPOINT, ID 83864-8311
(208) 263-7998
Mailing address
1905 PINE ST, SANDPOINT, ID 83864-8311
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT-1865
ID
225X00000X
Occupational Therapist
Primary
OTP-OT-LIC-9952
MT
Other
Enumeration date
06/11/2018
Last updated
11/11/2025
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