Individual
KANNA SHEPHERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LOTR
Contact information
Practice address
4701 MONTGOMERY BLVD NE, ALBUQUERQUE, NM 87109-1219
(505) 727-7800
Mailing address
PO BOX 654, LAKE PROVIDENCE, LA 71254-0654
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
200683
LA
Other
Enumeration date
05/16/2019
Last updated
05/16/2019
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