Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 020913-01 | NY |
NPI | 1083366199 |
---|---|
Provider Name | Stephanie Shepherd |
First Address | Horseheads, NY 14845-7287 |
Second Address | Horseheads, NY 14845-8302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |