Individual
ALLIE E SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5411 I 55 N, JACKSON, MS 39206-3616
(769) 251-2098
Mailing address
107 MUIRFIELD LN, CLINTON, MS 39056-5960
(601) 906-5709
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
TA3273
MS
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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