Basic Information
| Provider Information | |||||||||
| NPI: | 1437533882 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPHERD | ||||||||
| FirstName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 191 | ||||||||
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| City: | ROCKLAND | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197320191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026514945 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1280 ALMONESSON RD | ||||||||
| Address2: | |||||||||
| City: | DEPTFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080965502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563451401 | ||||||||
| FaxNumber: | 8568059370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2015 | ||||||||
| LastUpdateDate: | 12/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | U1-0001570 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
No ID Information.