Provider Demographics
NPI:1760828925
Name:SHEPHERD, KRISTIN (OTR/L)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
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 1:448 SIDNEY BAKER ST S
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5915
Mailing Address - Country:US
Mailing Address - Phone:830-896-3130
Mailing Address - Fax:832-896-3132
Practice Address - Street 1:448 SIDNEY BAKER ST S
Practice Address - Street 2:SUITE 103
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5915
Practice Address - Country:US
Practice Address - Phone:830-896-3130
Practice Address - Fax:832-896-3132
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115475174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist