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General NPI Number Information
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NPI Number | 1366852881
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Entity Type | Individual
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Provider Name | JESSICA MARIE SHIELDS M.S.
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Gender | Female
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Dates
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Enumeration Date | 05/06/2014
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 4560 SE INTERNATIONAL WAY SUITE 101
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City | MILWACKIE
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State | OR
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Zip | 97222
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Country | US
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Telephone | 971-206-5202
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Fax | 971-206-5263
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Provider Business Mailing Address
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Address Line | 455 GRIZZLY STREET
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City | AUMSVILLE
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State | OR
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Zip | 97325
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Country | US
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Telephone | 518-390-4910
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 324241
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License Number State | OR
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