Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OC003417L | PA |
NPI | 1003054073 |
---|---|
Provider Name | Darlene Marie Shephard |
First Address | Indiana, PA 15701-3629 |
Second Address | Indiana, PA 15701-3629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2009 |
Last Update Date | 29/01/2009 |