Active NPI
Shelby Laura Raymond
- Recreation Therapist
- Lake City, MI
National Provider Identifier
1952047847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 86207
- Practice address
- 301 N Main St
Lake City, MI 49651-5102 - Phone
- (231) 295-1196
- NPI assigned
- May 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 86207 | MI | Primary |
Addresses
Primary practice location
301 N Main St
Lake City, MI 49651-5102
Mailing address
4249 E Herrick Rd
Clare, MI 48617-9325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86207 | MI | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727740800000",
"number": "1952047847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4249 E HERRICK RD",
"city": "CLARE",
"state": "MI",
"postal_code": "486179325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N MAIN ST",
"city": "LAKE CITY",
"state": "MI",
"postal_code": "496515102",
"telephone_number": "231-295-1196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYMOND",
"first_name": "SHELBY",
"middle_name": "LAURA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-12",
"last_updated": "2024-10-01",
"certification_date": "2024-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "MI",
"license": "86207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.