Basic Information
| Provider Information | |||||||||
| NPI: | 1164442307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHEPHERD | ||||||||
| FirstName: | JENNY | ||||||||
| MiddleName: | LYN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3609 SW MAPLE CT | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500232956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159883881 | ||||||||
| FaxNumber: | 5159650841 | ||||||||
| Practice Location | |||||||||
| Address1: | 605 NE LOWELL DR | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500214701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5159883881 | ||||||||
| FaxNumber: | 5159650841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 01234 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.