Individual provider Active NPI

Shelby Moore Ray, OTR

  • Occupational Therapist
  • Ridgeland, MS
National Provider Identifier
1306408398
Registry record updated Jul 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Practice address
207 W Jackson St Ste 2
Ridgeland, MS 39157-2355
Phone
(601) 212-0870
NPI assigned
Jul 1, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X Primary

Addresses

Primary practice location

207 W Jackson St Ste 2
Ridgeland, MS 39157-2355

Mailing address

207 W Jackson St Ste 2
Ridgeland, MS 39157-2355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210915000765 MS Practitioner - Occupational Therapist in Private Practice 4587060637 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Therapy LLC CurrentSince Aug 20, 2021 Accepting new patients
Laskin Therapy Group, P.a. PastSince Jun 12, 2022 Accepting new patients

Locations

1301 W Government St
Ste 104
Brandon, MS 39042
Phone (601) 591-7535

921 W Beacon St
Philadelphia, MS 39350
Phone (601) 650-0002

1058 Holland Ave
Philadelphia, MS 39350
Phone (601) 650-0002

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1561939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561939200000",
    "number": "1306408398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 W JACKSON ST STE 2",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W JACKSON ST STE 2",
            "city": "RIDGELAND",
            "state": "MS",
            "postal_code": "391572355",
            "telephone_number": "601-212-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAY",
        "first_name": "SHELBY",
        "middle_name": "MOORE",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-01",
        "last_updated": "2019-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgeland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.