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General NPI Number Information
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NPI Number | 1689302705
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Entity Type | Individual
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Provider Name | ALEXIS SHALLCROSS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 59 AVE D
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City | PERRYVILLE
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State | MD
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Zip | 21904
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Country | US
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Telephone | 410-642-2411
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Fax |
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Provider Business Mailing Address
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Address Line | 209 MANOR DR
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City | MIDDLETOWN
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State | DE
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Zip | 19709-6056
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Country | US
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Telephone | 302-540-6397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 09604
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License Number State | MD
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