Active NPI
Lisa Rae Tebo, OTR/L
- Occupational Therapist
- Tupper Lake, NY
National Provider Identifier
1992974802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 006114-1
- Practice address
- 5 Cherry LN
Tupper Lake, NY 12986-1075 - Phone
- (518) 359-9495
- NPI assigned
- Feb 25, 2008
- Last updated
- Feb 25, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 006114-1 | NY | Primary |
Addresses
Primary practice location
5 Cherry LN
Tupper Lake, NY 12986-1075
Mailing address
5 Cherry LN
Tupper Lake, NY 12986-1075
Phone (518) 359-9495
Other names 1
- Ms. Lisa Rae Shellhammer
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 |
|---|---|---|---|
| 006114-1 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203897600000",
"number": "1992974802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 CHERRY LN",
"city": "TUPPER LAKE",
"state": "NY",
"postal_code": "129861075",
"telephone_number": "518-359-9495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 CHERRY LN",
"city": "TUPPER LAKE",
"state": "NY",
"postal_code": "129861075",
"telephone_number": "518-359-9495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEBO",
"first_name": "LISA",
"middle_name": "RAE",
"name_prefix": "Mrs.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-25",
"last_updated": "2008-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "006114-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "SHELLHAMMER",
"middle_name": "RAE",
"prefix": "MS.",
"credential": "OTR/L",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tupper Lake, NY
- Jessica Snyder, RDN
- State of New York
- State of New York
- State of New York
- State of New York
- Tupper Lake Center LLC (Tupper Lake Center for Nursing and Rehabilitation)
- Tupper Lake Central School District
- Tupper Lake Volunteer Ambulance & Emergency Squad Inc
- Walgreen Co (Walgreens #19706)
- Matthew S Warner, RPH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 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.