Provider Demographics
NPI:1043454036
Name:SHEPHERD, DANA LAUREN (MS, OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:DANA
Middle Name:LAUREN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 SAGEBRUSH BND
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-6349
Mailing Address - Country:US
Mailing Address - Phone:704-941-0995
Mailing Address - Fax:
Practice Address - Street 1:2814 GRAY FOX ROAD
Practice Address - Street 2:PEDIATRIC BOULEVARD
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110
Practice Address - Country:US
Practice Address - Phone:704-821-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8582225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics