Jackpot

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT2492 Issued in ME

Legal business name

JACKPOT

Doing business as

Casco Wellness Center

Practice address

5 S Casco Village Rd
Casco, ME 04015-4246

Phone

(207) 655-2520

NPI assigned

May 2, 2008

Last updated

May 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Lori Ann Shaw, L.M.T.NPI 1902059702

Title

Coordinator

Phone

(207) 655-2520

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Casco Wellness Center Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lori Ann Shaw, L.M.T.

  • Massage Therapist
  • Casco, ME
  • NPI 1902059702
  NPD (past) Authorized official

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209686400000",
    "number": "1386810034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 S CASCO VILLAGE RD",
            "city": "CASCO",
            "state": "ME",
            "postal_code": "040154246",
            "telephone_number": "207-655-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 S CASCO VILLAGE RD",
            "city": "CASCO",
            "state": "ME",
            "postal_code": "040154246",
            "telephone_number": "207-655-2520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKPOT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-02",
        "last_updated": "2008-05-02",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "COORDINATOR",
        "authorized_official_telephone_number": "207-655-2520",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "L.M.T."
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "ME",
            "license": "MT2492",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "200719",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Casco Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Massage Therapist in Casco, ME
• Providers in Casco, ME by specialty
• Massage Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.