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General NPI Number Information
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NPI Number | 1346659463
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Entity Type | Individual
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Provider Name | EMILCE SHEPPARD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 3737 W MAIN ST STE 101
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City | SALEM
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State | VA
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Zip | 24153-2073
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Country | US
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Telephone | 540-444-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 3737 W MAIN ST STE 101
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City | SALEM
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State | VA
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Zip | 24153-2073
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306602085
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 0121000800
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License Number State | VA
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