Provider Demographics
NPI:1831685015
Name:SHALLCROSS, AINSLEY TOMPKINS (CTRS, CDP)
Entity type:Individual
Prefix:
First Name:AINSLEY
Middle Name:TOMPKINS
Last Name:SHALLCROSS
Suffix:
Gender:F
Credentials:CTRS, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2722
Mailing Address - Country:US
Mailing Address - Phone:407-748-8998
Mailing Address - Fax:
Practice Address - Street 1:50 BEALE ST FL 12
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-1813
Practice Address - Country:US
Practice Address - Phone:415-516-4489
Practice Address - Fax:415-516-4389
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68947225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist