Provider Demographics
NPI:1245447523
Name:SHIRLEY A AUCHINCLOSS OTR PC
Entity type:Organization
Organization Name:SHIRLEY A AUCHINCLOSS OTR PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AUCHINCLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:520-803-9733
Mailing Address - Street 1:5528 LAGUNA AVENUE
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650
Mailing Address - Country:US
Mailing Address - Phone:520-803-9733
Mailing Address - Fax:520-803-9420
Practice Address - Street 1:5528 LAGUNA AVENUE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650
Practice Address - Country:US
Practice Address - Phone:520-803-9733
Practice Address - Fax:520-803-9420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAMCCS 771049Medicaid
AZ68534Medicare ID - Type Unspecified
AZAMCCS 771049Medicaid