Provider Demographics
NPI:1164442307
Name:SHEPHERD, JENNY LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYN
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 1:3609 SW MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2956
Mailing Address - Country:US
Mailing Address - Phone:515-988-3881
Mailing Address - Fax:515-965-0841
Practice Address - Street 1:605 NE LOWELL DR
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4701
Practice Address - Country:US
Practice Address - Phone:515-988-3881
Practice Address - Fax:515-965-0841
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01234225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist