Provider Demographics
NPI:1558795088
Name:SHEPHERD, NATALIE CYNTHIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:CYNTHIA
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 1:95 MEADOW WOOD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-7022
Mailing Address - Country:US
Mailing Address - Phone:423-552-8647
Mailing Address - Fax:
Practice Address - Street 1:95 MEADOW WOOD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-7022
Practice Address - Country:US
Practice Address - Phone:423-552-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000002869225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics