Provider Demographics
NPI:1972253730
Name:CARROLL, AINSLEY MICHELE
Entity Type:Individual
Prefix:
First Name:AINSLEY
Middle Name:MICHELE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KITTIWAKE CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-9791
Mailing Address - Country:US
Mailing Address - Phone:916-359-7717
Mailing Address - Fax:
Practice Address - Street 1:7 KITTIWAKE CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-9791
Practice Address - Country:US
Practice Address - Phone:916-359-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer