Individual
MRS. MICHELLE G SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOTRL
Contact information
Practice address
1000 HOLCOMB WOODS PKWY, STE426, ROSWELL, GA 30076-2575
(770) 641-8070
(770) 698-4178
Mailing address
700 AMSTER GREEN DR, ATLANTA, GA 30350-4139
(770) 851-9553
(770) 698-4178
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000959758A
—
GA
01
—
930129
BCBS PIN
GA
Enumeration date
12/28/2006
Last updated
05/20/2008
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