Individual
MR. KEITH SELLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR L
Contact information
Practice address
9815 SANDMAN LN, CHARLOTTE, NC 28216-1795
(704) 771-0051
Mailing address
PO BOX 691775, MINT HILL, NC 28227-7030
(704) 771-0051
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2706
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7301011
—
NC
Enumeration date
02/26/2007
Last updated
07/09/2007
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