Individual
MR. SHANE KENNETH MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
310 E BROADWAY AVE, JACKSON, WY 83001-8636
(307) 734-2877
(307) 734-2827
Mailing address
555 SAINT JOSEPHS BLVD, ELMIRA, NY 14901-3223
(607) 733-6541
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1386
WY
Other
Enumeration date
12/13/2012
Last updated
07/01/2020
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