Provider Demographics
NPI:1104129915
Name:SHEPERD, KRISTIN (LADC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SHEPERD
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-0097
Mailing Address - Country:US
Mailing Address - Phone:802-503-8728
Mailing Address - Fax:
Practice Address - Street 1:12 FAIRFIELD HILL RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9634
Practice Address - Country:US
Practice Address - Phone:802-524-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner