MEDICARE: SAMANTHA SHEPERD

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
1	106S00000X	Behavior Technician	ABA-IN-10272690	OR

General Provider Information

NPI Number	:	1306772694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA SHEPERD

Provider Business Mailing Address
First Line	:	3552 LONE PINE RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-5637
Country	:	US
Telephone Number	:	541-613-3400
Fax Number	:	458-226-2249

Provider Business Practice Location Address
First Line	:	3552 LONE PINE RD
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-5637
Country	:	US
Telephone Number	:	541-613-3400
Fax Number	:	458-226-2249

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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Directions to “ SAMANTHA SHEPERD ” Practice Location

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