Shane Kenneth McCormick, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT-1386 Issued in WY

Practice address

310 E Broadway Ave
Jackson, WY 83001-8636

Phone

(307) 734-2877

Fax

(307) 734-2827

NPI assigned

Dec 13, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Teton Hand Therapy LLCGroup PAC ID 4385549443, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Teton Hand Therapy LLC

  • Hand Occupational Therapist
  • Jackson, WY
  • NPI 1215086905
  Medicare reassignment Care Compare group NPD
• Teton Hand Therapy, Inc.

  dba Teton Hand Therapy LLC

  • Durable Medical Equipment & Medical Supplies
  • Gunnison, CO
  • NPI 1962785626
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593561600000",
    "number": "1295071611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 SAINT JOSEPHS BLVD",
            "city": "ELMIRA",
            "state": "NY",
            "postal_code": "149013223",
            "telephone_number": "607-733-6541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018636",
            "telephone_number": "307-734-2877",
            "fax_number": "307-734-2827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "SHANE",
        "middle_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-13",
        "last_updated": "2020-07-01",
        "certification_date": "2020-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "WY",
            "license": "OT-1386",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte K Mason, FNP
• Daniel R McAleese, P.T.
• Natalie Alicia McBranch, PA-C
• Madison McBride, OTR/L
• Matthew S McBride, DPT
• Sarah Katherine McDaniel, CRNA
• Anna McDonough, LPA, LPC
• Henry Michael McElroy, CRNA
• Chase McFadden, RBT
• Lisa Dardy McGee

• Occupational Therapist in Jackson, WY
• Providers in Jackson, WY by specialty
• Occupational Therapist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.