Provider Demographics
NPI:1932888252
Name:OGUIBE-SHEPHERD, EZIAMARA (OTR/L)
Entity type:Individual
Prefix:DR
First Name:EZIAMARA
Middle Name:
Last Name:OGUIBE-SHEPHERD
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 BOROWICK CIR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-8311
Mailing Address - Country:US
Mailing Address - Phone:202-718-6534
Mailing Address - Fax:
Practice Address - Street 1:3100 BOROWICK CIR
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8311
Practice Address - Country:US
Practice Address - Phone:202-718-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY286739225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty