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1295071611
SHANE KENNETH MCCORMICK
JACKSON, WY
NPI
1295071611
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: WY OT-1386)
Enumeration Date
2012-12-13
Last Update Date
2020-07-01
Business Address
Mr. SHANE KENNETH MCCORMICK OTR/L
310 E BROADWAY AVE
JACKSON, WY 83001-8636
Phone number: 307-734-2877
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Mailing Address
Mr. SHANE KENNETH MCCORMICK OTR/L
555 SAINT JOSEPHS BLVD
ELMIRA, NY 14901-3223
Phone number: 607-733-6541
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