Provider Demographics
NPI:1487754388
Name:SHEPHERD, NANCY LEE (COTA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:TUNENDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:565 NW HOLLY STREET
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-837-7000
Mailing Address - Fax:
Practice Address - Street 1:565 NW HOLLY STREET
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-837-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60563970224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
60563970OtherCOTA