Provider Demographics
NPI:1740636521
Name:SHEPHERD, DAWN (COTA)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 WASSOM ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-1169
Mailing Address - Country:US
Mailing Address - Phone:541-990-9287
Mailing Address - Fax:
Practice Address - Street 1:875 WASSOM ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-1169
Practice Address - Country:US
Practice Address - Phone:541-990-9287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR349597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist