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General NPI Number Information
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NPI Number | 1992340640
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Entity Type | Individual
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Provider Name | TAYLOR M SHEPHERD LMT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2019
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 113 W FRONT ST STE 102
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City | NOME
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State | AK
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Zip | 99762-9800
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Country | US
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Telephone | 907-443-7477
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 S COLONY WAY STE 3
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City | PALMER
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State | AK
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Zip | 99645-6972
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 11240850-4701
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License Number State | UT
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