BUCK JACK LLC (NPI# 1376141572) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376141572 |
| Entity Type | Organization |
| Organization Name | BUCK JACK LLC |
| Practice Address |
1321 S Prairie Ave Pueblo CO 81005-2307 |
| 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 | 2020-10-12 |
| Last Update Date | 2020-10-12 |
| 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 |
| 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 |
| 1174121487 | Buck Jack LLC | Behavioral Analyst | 17230 Jackson Creek Pkwy Ste 220, Monument, CO 80132-7304 | 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 |
1321 S PRAIRIE AVE |
| City | PUEBLO |
| State | CO |
| Zip Code | 81005-2307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891268900 | Stephanie Michaela Johnson | Physical Therapist | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2019-01-10 |
| 1346847910 | Amy Shandy, Speech-language Pathologist, LLC | Behavioral Analyst | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-10-06 |
| 1295342343 | Amanda Davis | Physical Therapist | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-09-23 |
| 1982219176 | Amy Shandy, Speech-language Pathologist, LLC | Physical Therapist | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-09-14 |
| 1538774385 | Kelly Hunter | Speech-Language Pathologist | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-09-09 |
| 1982217097 | Buck Jack LLC | Behavioral Analyst | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-08-28 |
| 1114545084 | Adrianna Reich | Speech-Language Pathologist | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2020-07-08 |
| 1477196426 | Emily Jane Kartiganer | Occupational Therapist | 1321 S Prairie Ave, Pueblo, CO 81005-2307 | 2019-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225595630 | Kimberly Warfield | Specialist | 5825 W Hwy 78, Pueblo, CA 81005 | 2019-02-22 |
| 1417461823 | Yah Vision | Optometrist | 2568 Taylor Ln, Pueblo, CO 81005 | 2017-11-21 |
| 1245758168 | Jenny C Alas | Dentist | 2603 Vinewood Lane, Pueblo, CO 81005 | 2017-08-30 |
| 1801342472 | Cynthia Watson | Counselor | 2429 S. Prairie Avenue, Pueblo, CO 81005 | 2016-09-01 |
| 1598033664 | Kyle Andrew Bonds | Pharmacist | 2900 W. Northern Ave., Pueblo, CO 81005 | 2011-12-05 |
| 1346406196 | Samantha Coleman | Counselor | 2429 S Prairie Ave, Pueblo, CO 81005 | 2008-07-31 |
| 1184890915 | Hg Stringert Dds, Ms, PC | Dentist | 3955 Sandlewood Lane, Pueblo, CO 81005 | 2008-05-01 |
| 1992902423 | David Russell Baer | Dentist | 2041 Pepper Lane, Ste A, Pueblo, CO 81005 | 2007-06-28 |
| 1659443695 | Thomas Wesley Ready | Dentist | 643 So Pueblo Blvd, Pueblo, CO 81005 | 2006-11-14 |
| 1700969029 | Bradley Michael Almond | Dentist | 1221 S Pueblo Blvd, Pueblo, CO 81005 | 2006-10-23 |
| Find all providers in zip 81005 | ||||
| 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 |
|---|---|---|---|---|
| 1871107904 | Samantha Kaisha Mcneely | Occupational Therapist | 714 W Orman Ave, Pueblo, CO 81004-1428 | 2020-09-05 |
| 1669966057 | Alexander Lyon | Occupational Therapist | 3143 E Spaulding Ave Apt 102, Pueblo, CO 81008-2225 | 2018-06-19 |
| 1154820488 | Brandy Bregar | Occupational Therapist | 1718 Tierra Berienda, Pueblo, CO 81008-2610 | 2018-02-01 |
| 1720502776 | Esme Gevira Label | Occupational Therapist | 4739 Eagleridge Cir Apt 208, Pueblo, CO 81008-2267 | 2017-08-01 |
| 1700313459 | Allison Vigil | Occupational Therapist | 1600 W. 24th St, Pueblo, CO 81003 | 2017-05-12 |
| 1073048633 | Cathy Bowman | Occupational Therapist | 820 Baxter Rd, Pueblo, CO 81006-9578 | 2017-04-20 |
| 1982145488 | Nicole Luisa Cummings | Occupational Therapist | 4304 Muirfield Rd, Pueblo, CO 81001-1167 | 2017-03-16 |
| 1619352762 | Shannon Conn | Occupational Therapist | 6464 Dillon Dr Unit 3, Pueblo, CO 81008-1956 | 2015-07-29 |
| 1558607267 | Nathan Melito | Occupational Therapist | 412 Colorado Ave, Pueblo, CO 81004-2011 | 2012-12-27 |
| 1487999280 | Josh A Corbin | Occupational Therapist | 4753 Eagleridge Cir, Apt 204, Pueblo, CO 81008-2128 | 2012-12-05 |
| Find all providers in PUEBLO | ||||
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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.