BUCK JACK LLC (NPI# 1053919365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053919365 |
| Entity Type | Organization |
| Organization Name | BUCK JACK LLC |
| Practice Address |
6190 Barnes Rd Colorado Springs CO 80922-2600 |
| Mailing Address |
685 Citadel Dr E Ste 580 Colorado Springs CO 80909-5381 |
| Practice Telephone | 7195970822 |
| Practice Fax Number | 7195994606 |
| Mailing Telephone | 7195970822 |
| Mailing Fax Number | 7195994606 |
| Enumeration Date | 2020-10-09 |
| Last Update Date | 2020-10-09 |
| Authorized Official Name | REBECCA NEWMAN (BILLING MANAGER) |
| Authorized Official Telephone | 7195970822 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103K00000X | Behavioral Analyst | Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| Y | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Other Name | Type Code |
|---|---|
| THE SHANDY CLINIC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083212393 | Buck Jack LLC | Physical Therapist | Mountain View Core Knowledge School 890 Field Ave, Cannon City, CO 81212 | 2020-10-09 |
| 1912505116 | Buck Jack LLC | Behavioral Analyst | 1301 Fortino Blvd, Pueblo, CO 81008-2032 | 2020-10-12 |
| 1376141572 | Buck Jack LLC | Behavioral Analyst | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-10-12 |
| 1568060754 | Buck Jack LLC | Behavioral Analyst | 830 Tenderfoot Hill Rd Ste 100, Colorado Springs, CO 80906-7372 | 2020-10-12 |
| 1730787920 | Buck Jack LLC | Behavioral Analyst | 917 E Moreno Ave Ste 150, Colorado Springs, CO 80903-4547 | 2020-10-12 |
| 1467050658 | Buck Jack LLC | Behavioral Analyst | 901 N Santa Fe Ave, Fountain, CO 80817-1738 | 2020-10-12 |
| 1104424423 | Buck Jack LLC | Behavioral Analyst | 3625 Citadel Dr S, Colorado Springs, CO 80909-5320 | 2020-10-09 |
| 1497353700 | Buck Jack LLC | Physical Therapist | 2233 Academy Pl Ste 201, Colorado Springs, CO 80909-1679 | 2020-10-09 |
| 1942808258 | Buck Jack LLC | Behavioral Analyst | 8540 Scarborough Dr Ste 300, Colorado Springs, CO 80920-7519 | 2020-10-09 |
| 1619575909 | Buck Jack LLC | Physical Therapist | 3901 E Yale Ave, Denver, CO 80210-6646 | 2020-10-09 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Buck Jack LLC | 419 South Tejon Appt. 309, Colorado Springs, CO 80903 |
| Street Address |
6190 BARNES RD |
| City | COLORADO SPRINGS |
| State | CO |
| Zip Code | 80922-2600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861494155 | Edward T Kimble | Specialist | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2005-06-01 |
| 1619574282 | Amy Shandy, Speech-language Pathologist, LLC | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-10-06 |
| 1518572841 | Amy Shandy, Speech-language Pathologist, LLC | Psychologist | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-09-14 |
| 1427663756 | Amy Shandy, Speech-language Pathologist, LLC | Behavior Technician | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-09-14 |
| 1417562323 | Michaela Harris | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-09-09 |
| 1215548425 | Buck Jack LLC | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-08-11 |
| 1619587409 | Buck Jack LLC | Behavioral Analyst | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-08-06 |
| 1669080719 | Esther L Bednar | Behavior Technician | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-07-15 |
| 1679191670 | Elizabeth Dandino | Behavior Technician | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-07-07 |
| 1568084846 | Mckenzie Kist | Speech-Language Pathologist | 6190 Barnes Rd, Colorado Springs, CO 80922-2600 | 2020-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427662709 | Emergency Medical Specialists, PC | Emergency Medicine | Powers Fsed - Md, 2770 N. Powers Blvd, Colorado Springs, CO 80922 | 2020-09-03 |
| 1578177895 | Emergency Medical Specialists, PC | Emergency Medicine | Powers Fsed - App, 2770 N. Powers Blvd, Colorado Springs, CO 80922 | 2020-09-03 |
| 1528566965 | Caitlin Corbeit Kroetsch | Massage Therapist | 5349 Ferraro Drive, Colorado Springs, CO 80922 | 2018-01-31 |
| 1154861169 | Miriam Freire | Dental Hygienist | 3759 Swainson Dr., Colorado Springs, CO 80922 | 2017-02-24 |
| 1528507712 | Brandon Hutchinson | Social Worker | 6972 Hillock Fr, Colorado Springs, CO 80922 | 2017-02-21 |
| 1841648052 | Delene Suzuki Babauta | Dental Assistant | 7279 Withers Pl, Colorado Springs, CO 80922 | 2016-05-27 |
| 1225442601 | Betsy Titus | Physical Therapy Assistant | 6355 Silverado Trl, Colorado Springs, CO 80922 | 2014-06-13 |
| 1255754214 | Lynor Dicang Hardy | Military Health Care Provider | Cheyenne Mountain Air Station, Colorado Springs, CO 80922 | 2014-01-28 |
| 1861774184 | North Powers Modern Dentistry, LLP | Dentist | 5430 Tutt Boulevard, Colorado Springs, CO 80922 | 2011-09-13 |
| 1255589297 | Kendra D Robison | Internal Medicine | 6340 E Barnes Road, Colorado Springs Health Partners Internal Medicine, Colorado Springs, CO 80922 | 2008-09-03 |
| Find all providers in zip 80922 | ||||
| Taxonomy Code | 225X00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapist |
| An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629678289 | Life Wheels On PC | Occupational Therapist | 2248 Vintage Dr, Colorado Springs, CO 80920-3808 | 2020-10-31 |
| 1003434937 | Treehouse Occupational Therapy, LLC | Occupational Therapist | 840 E Monument St Apt 4, Colorado Springs, CO 80903-2842 | 2020-07-07 |
| 1144855255 | Health Promotion Partners, LLC | Occupational Therapist | 2924 Beacon St Ste D, Colorado Springs, CO 80907-6195 | 2020-03-09 |
| 1871124057 | Margaret Elizabeth Macnabb | Occupational Therapist | 955 West Fillmore Street, Colorado Springs, CO 80907 | 2020-01-28 |
| 1952931198 | Maya Anderson | Occupational Therapist | 1765 Seclusion Pt Apt D, Colorado Springs, CO 80918-7959 | 2020-01-16 |
| 1831738533 | Brian Edward Zita | Occupational Therapist | 6680 Glade Park Dr, Colorado Springs, CO 80918-4719 | 2019-12-27 |
| 1114564390 | Sydney Kathryn Fleege | Occupational Therapist | 7873 Lightwood Way, Colorado Springs, CO 80908-5635 | 2019-12-05 |
| 1528622966 | Jenna Moxley | Occupational Therapist | 6861 Oak Vine Ct, Colorado Springs, CO 80908-4729 | 2019-04-30 |
| 1396219010 | Tory Weinstein | Occupational Therapist | 4760 Whimsical Dr, Colorado Springs, CO 80917-3218 | 2019-01-15 |
| 1316429624 | Premere Rehab LLC | Occupational Therapist | 7600 Sandy Rock Point, Melody Living, Colorado Springs, CO 80924-5222 | 2018-09-04 |
| Find all providers in COLORADO SPRINGS | ||||
| City | COLORADO SPRINGS |
| Zip Code | 80922 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.