Healthcare Provider Details

I. General information

NPI: 1043454036
Provider Name (Legal Business Name): DANA LAUREN SHEPHERD MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 GRAY FOX ROAD PEDIATRIC BOULEVARD
MONROE NC
28110
US

IV. Provider business mailing address

3021 SAGEBRUSH BND
MONROE NC
28110-6349
US

V. Phone/Fax

Practice location:
  • Phone: 704-821-0568
  • Fax:
Mailing address:
  • Phone: 704-941-0995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number8582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: