Healthcare Provider Details

I. General information

NPI: 1093780793
Provider Name (Legal Business Name): ALLISON PAGE SHEPHERD MA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF VERMONT 140 PATRICK GYM/97 SPEAR ST.
BURLINGTON VT
05405-0001
US

IV. Provider business mailing address

323 BISCAYNE HTS
COLCHESTER VT
05446-6934
US

V. Phone/Fax

Practice location:
  • Phone: 802-656-9022
  • Fax: 802-656-9578
Mailing address:
  • Phone: 802-656-9022
  • Fax: 802-656-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number104-0000132
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: