Individual
MISS BROOKE ALEXIS HAILSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
159 W 1ST ST, OSWEGO, NY 13126-2045
(315) 342-9575
Mailing address
39 DAVIS ST APT F, PHOENIX, NY 13135-2045
(607) 316-4004
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
029562
NY
Other
Enumeration date
10/07/2024
Last updated
10/07/2024
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