Individual
MS. LAMONICA LYNIECE HAIRSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
14306 DANTE AVE, DOLTON, IL 60419-1326
(708) 248-4456
Mailing address
14306 DANTE AVE, DOLTON, IL 60419-1326
(708) 248-4456
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004306
IL
Other
Enumeration date
11/17/2015
Last updated
11/17/2015
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