Provider Demographics
NPI:1154401917
Name:AUCHINCLOSS, SHIRLEY A (OTR OTRL)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:AUCHINCLOSS
Suffix:
Gender:F
Credentials:OTR OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5528 S LAGUNA AVE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9770
Mailing Address - Country:US
Mailing Address - Phone:520-803-9733
Mailing Address - Fax:520-803-9420
Practice Address - Street 1:5528 S LAGUNA AVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-9770
Practice Address - Country:US
Practice Address - Phone:520-803-9733
Practice Address - Fax:520-803-9420
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0022225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ771049Medicaid
AZ68535 / 68534Medicare PIN
Z68535Medicare PIN