MEDICARE: TETON HAND THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	OT059	WY
2	332BC3200X	Customized Equipment (DME)	OT059	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	785001	OTHER	WY	BLUE SHIELD GROUP

General Provider Information

NPI Number	:	1275747628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TETON HAND THERAPY LLC

Provider Business Mailing Address
First Line	:	PO BOX 4596
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-4596
Country	:	US
Telephone Number	:	307-734-2877
Fax Number	:	307-734-2827

Provider Business Practice Location Address
First Line	:	310 EAST BROADWAY
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-0000
Country	:	US
Telephone Number	:	307-734-2877
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, MANAGER
Name	:	MS. CYNTHIA C GRIGGS
Credential	:	OTR, CHT
Telephone Number	:	307-734-2877

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	10/23/2012

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Directions to “TETON HAND THERAPY LLC ” Practice Location

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