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General NPI Number Information
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NPI Number | 1609441294
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Entity Type | Individual
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Provider Name | ELLEN BAILEY SHEPHERD OTD, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 807 W JEFFERSON ST UNIT U
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City | SHOREWOOD
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State | IL
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Zip | 60404-7301
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Country | US
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Telephone | 814-714-2977
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Fax |
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Provider Business Mailing Address
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Address Line | 225 N PARK ST
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City | MANHATTAN
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State | IL
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Zip | 60442-8142
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Country | US
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Telephone | 815-955-6576
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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 | 056.013699
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License Number State | IL
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