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NPI Code Detail

MEDICARE: CHARIS D SHEPHARD COTA/L

MEDICARE: CHARIS D SHEPHARD COTA/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOTA002282GA

General Provider Information

NPI Number : 1306724745
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARIS D SHEPHARD COTA/L
Provider Business Mailing Address
First Line : 9975 NEUCHATEL CRES
Second Line :
City : JONESBORO
State : GA
Zip : 30238-6596
Country : US
Telephone Number : 770-899-4092
Fax Number :
Provider Business Practice Location Address
First Line : 2327 N HIGHWAY 27
Second Line :
City : CARROLLTON
State : GA
Zip : 30117-6701
Country : US
Telephone Number : 770-834-4404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2025
Last Update Date : 08/25/2025

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Directions to “ CHARIS D SHEPHARD COTA/L” Practice Location

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