Provider Demographics
NPI:1063065126
Name:SHEPHERD, TERRA BRAZELL (COTA)
Entity type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:BRAZELL
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:
Other - Last Name:BRAZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:687 LOW MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3725 WHEELER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6623
Practice Address - Country:US
Practice Address - Phone:706-868-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant