Active NPI
Keith Sellick, OTR L
- Occupational Therapist
- Charlotte, NC
National Provider Identifier
1235265703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 2706
- Practice address
- 9815 Sandman LN
Charlotte, NC 28216-1795 - Phone
- (704) 771-0051
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 2706 | NC | Primary |
Addresses
Primary practice location
9815 Sandman LN
Charlotte, NC 28216-1795
Mailing address
PO Box 691775
Mint Hill, NC 28227-7030
Phone (704) 771-0051
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7301011 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2706 | NC | MD | Sports Physician Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abc Pediatric Rehab | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172448000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1235265703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 691775",
"city": "MINT HILL",
"state": "NC",
"postal_code": "282277030",
"telephone_number": "704-771-0051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9815 SANDMAN LN",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282161795",
"telephone_number": "704-771-0051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELLICK",
"first_name": "KEITH",
"name_prefix": "Mr.",
"credential": "OTR L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "2706",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7301011",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.