Provider Demographics
NPI:1073385720
Name:SHEPHERD, AMELIA RHOADES (OTR/L)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:RHOADES
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 BENT TREE WAY
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-5818
Mailing Address - Country:US
Mailing Address - Phone:984-212-7344
Mailing Address - Fax:
Practice Address - Street 1:6346 CEPHIS DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9230
Practice Address - Country:US
Practice Address - Phone:336-404-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11572225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist