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General NPI Number Information
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NPI Number | 1801091194
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Entity Type | Individual
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Provider Name | CHRISTINE E SHEPHERD CMT, NCBTMB, LPC
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 37 N SCOTT ST STE 28
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City | SHERIDAN
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State | WY
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Zip | 82801-6361
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Country | US
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Telephone | 307-752-1387
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Fax | 307-672-8508
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Provider Business Mailing Address
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Address Line | 611 MOUNTAIN SHADOWS BLVD
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City | SHERIDAN
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State | WY
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Zip | 82801-9356
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Country | US
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Telephone | 307-752-1387
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Fax | 307-672-8508
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | NO LICENSING BOARD
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License Number State | WY
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