Provider Demographics
NPI:1306052907
Name:SHEPARD, AMY JO (BS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NORTH GREEN
Mailing Address - Street 2:
Mailing Address - City:MEREDOSIA
Mailing Address - State:IL
Mailing Address - Zip Code:62665-7106
Mailing Address - Country:US
Mailing Address - Phone:217-370-4172
Mailing Address - Fax:
Practice Address - Street 1:335 NORTH GREEN
Practice Address - Street 2:
Practice Address - City:MEREDOSIA
Practice Address - State:IL
Practice Address - Zip Code:62665-7106
Practice Address - Country:US
Practice Address - Phone:217-370-4172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist