Doctor Name: | TABATHA M SELLICK |
NPI Number: | 1518335777 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SW |
License Number: | |
Business Practice Address: | 167 Polk St Suite 300 Watertown, NY - 136012097 |
Business Phone Number: | 3157827445 |
Business Fax Number: | 3157791184 |
Mailing Address: | Po Box 6550, WATERTOWN |
State: | NY |
Postal Code: | 136016550 |
Phone Number: | 3157827445 |
Fax Number: | 3157791184 |
NPI Enumeration Date: | 09/04/2015 |
NPI Last Update Date: | 09/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |